Communications of the ACM

contributed articles

Doi: 10.1145/2447976.2447993

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
Collaboration
with a Robotic
Scrub Nurse

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

key insights

Gestonurse is the first multimodal robotic scrub nurse to assist surgeons by passing and retrieving surgical instruments during simple procedures.