Surgeons use hand gestures and/or voice
commands without interrupting the natural
flow of a procedure.
BY mithuN GeoRGe JaCoB, Yu-tiNG Li,
GeoRGe a. aKiNGBa, aND JuaN P. WaChS
with a Robotic
errors in the delivery of medical care are the principal
cause of inpatient mortality and morbidity ( 98,000
deaths annually in the U.S.). 16 Ineffective team
communication is often at the root of these errors. 7, 10, 16
For example, in assessing verbal and nonverbal
exchanges in the operating room (oR), Lingard et
al. 18 found frequent communication failure, with
commands delayed, incomplete, or not received at all,
as well as left unresolved. Firth-Cousins7 found 31%
of all communications in the oR represent failures, 7
with one-third of them having a negative effect on
patient outcomes. 7 And Halverson et al. 10 found 36% of
communication errors are related to equipment use.
Causes of errors include team instability (such as lack
of familiarity between nurses and surgeons), 5 lack of
resources (such as minimal staffing), and distractions.
Poor communication within a surgical team can result in
greater likelihood of instrument-count discrepancies
among team members, possibly indicating retention of surgical instruments in a patient’s body, with sponges and towels most common. 6
Adding a robot to the operating theater as an assistant to a surgical team
has the potential to reduce the number
of miscommunications and their negative effects in two main ways: First, in
the case of communication failure, a
robotic scrub nurse (such as our Gestonurse) is able to deliver surgical instruments to the main surgeon communicating through hand gestures
and speech recognition; timely, accurate surgical delivery to the surgeon
can lead to decreased cognitive load,
time, and effort for surgeons. And,
second, the possibility of retained surgical instruments is avoided through
accurate, thorough, timely tracking
and monitoring of instruments used;
retained instruments can puncture
organs and cause internal bleeding.
We have been developing Gestonurse
at Purdue University for the past three
years (see Figure 1).
The main use of robotics in surgery
is not to replace the surgeon or surgical nurses but to work with them during surgery. In working side by side
(see Figure 2), responsibility can be
divided up like this: The robot passes
instruments, sutures, and sponges
during surgery and keeps an inventory
of their use, while the surgical technician handles all remaining tasks (such
as operating sterilizers, lights, suction
machines, and electrosurgical units
and diagnostic equipment and holding
Gestonurse is the first multimodal
robotic scrub nurse to assist surgeons
by passing and retrieving surgical
instruments during simple procedures.
Gestonurse recognizes both hand
gestures and speech commands,
mapping them to existing surgical
instruments in a surgical tray.
Gestonurse recognizes and tracks
surgical instruments in use, retrieving
them for the procedure, thus reducing
the risk of retained instruments.