Surgical Robots Research Papers - Academia.edu (original) (raw)

tObjective: Errors in the delivery of medical care are the principal cause of inpatient mortality and mor-bidity, accounting for around 98,000 deaths in the United States of America (USA) annually. Ineffectiveteam communication, especially in the operation room (OR), is a major root of these errors. This mis-communication can be reduced by analyzing and constructing a conceptual model of communicationand miscommunication in the OR. We introduce the principles underlying Object-Process Methodology(OPM)-based modeling of the intricate interactions between the surgeon and the surgical technicianwhile handling surgical instruments in the OR. This model is a software- and hardware-independentdescription of the agents engaged in communication events, their physical activities, and their interac-tions. The model enables assessing whether the task-related objectives of the surgical procedure wereachieved and completed successfully and what errors can occur during the communication.Methods and material: The facts used to construct the model were gathered from observations of varioustypes of operations miscommunications in the operating room and its outcomes. The model takes advan-tage of the compact ontology of OPM, which is comprised of stateful objects – things that exist physicallyor informatically, and processes – things that transform objects by creating them, consuming them orchanging their state. The modeled communication modalities are verbal and non-verbal, and errors aremodeled as processes that deviate from the “sunny day” scenario. Using OPM refinement mechanism ofin-zooming, key processes are drilled into and elaborated, along with the objects that are required asagents or instruments, or objects that these processes transform. The model was developed through aniterative process of observation, modeling, group discussions, and simplification.Results: The model faithfully represents the processes related to tool handling that take place in an ORduring an operation. The specification is at various levels of detail, each level is depicted in a separatediagram, and all the diagrams are “aware” of each other as part of the whole model. Providing ontology ofverbal and non-verbal modalities of communication in the OR, the resulting conceptual model is a solidbasis for analyzing and understanding the source of the large variety of errors occurring in the courseof an operation, providing an opportunity to decrease the quantity and severity of mistakes related tothe use and misuse of surgical instrumentations. Since the model is event driven, rather than persondriven, the focus is on the factors causing the errors, rather than the specific person. This approach advo-cates searching for technological solutions to alleviate tool-related errors rather than finger-pointing.Concretely, the model was validated through a structured questionnaire and it was found that surgeonsagreed that the conceptual model was flexible (3.8 of 5, std = 0.69), accurate, and it generalizable (3.7 of5, std = 0.37 and 3.7 of 5, std = 0.85, respectively).Conclusion: The detailed conceptual model of the tools handling subsystem of the operation performed inan OR focuses on the details of the communication and the interactions taking place between the surgeonand the surgical technician during an operation, with the objective of pinpointing the exact circumstancesin which errors can happen. Exact and concise specification of the communication events in general andthe surgical instrument requests in particular is a prerequisite for a methodical analysis of the variousmodes of errors and the circumstances under which they occur. This has significant potential value in both reduction in tool-handling-related errors during an operation and providing a solid formal basis fordesigning a cybernetic agent which can replace a surgical technician in routine tool handling activitiesduring an operation, freeing the technician to focus on quality assurance, monitoring and control ofthe cybernetic agent activities. This is a critical step in designing the next generation of cybernetic OR assistants.