Robots in the Operating Room: Improving Training and Safety

Surgical robots are transforming the operating room. They deliver many benefits but also present new challenges. That is why the efficient handling of robotic mechanisms must also be reflected in the respective training courses.

In this interview, Professor Korb explains how the mySebastian software is a great way to improve robotic surgery training programs.

Prof. Werner Korb, what is your assessment of the human-robot collaboration in the operating room?

Prof. Werner Korb: In the past, usability and human-technology interaction was not as advanced as it is today. By now, user satisfaction has increased significantly. Companies invest a great deal of money in these processes. The daVinci surgical system is a trailblazer in this area and represented an advanced robotic platform even then. The daVinci system made ergonomic design in surgery a focal point. Back then, I worked in Leipzig and did research with the daVinci system. I later became a Professor of Simulation and Ergonomics in Operative Medicine. We have started to systematically analyze how usability and ergonomics in the operating room can be further improved and advanced. Today, the basic configuration, the technology, and the development facilitate efficient collaboration.

What areas need improvement?

Korb: Training is the biggest area for improvement. Robot manufacturers have their own academies for this. Training programs are used to train robots for laparoscopy, prostatectomy and other surgical specialties. However, training concepts and robotic systems are still largely developed separately. That’s why my suggestion is to integrate the training into the development process of robots right from the start. Just as usability and risk management have been an integral part of the development process from the get-go, training - including advanced pedagogy - should likewise be an essential component of development processes.

What concepts are you currently researching in this area?

Korb: We currently study the seamless integration of surgical training into both medical device development and everyday surgical practice. The goal of our research is to document surgical workflows to make them available and accessible for workshops and budding surgeons who are inexperienced in robotic surgery. We are currently in talks with potentially interested parties pertaining to robotics. There is already a beta version of the software program, which is currently being tested on the webserver. It is called mySebastian and was developed as part of the "Sensor Based Surgery Training - Integrated system and Analytics (SeBaSTIAn)" project.

How does the software work?

Korb: This is how the solution works: Once a surgeon has created an interesting case study video, the goal is to make it available in a database in a format that is easy to understand and structured. The idea is to break down all cases and thus the entire training program based on surgical procedures into a simple, short series of workflow steps, which are then linked together in the background. Common surgical procedures always vary, which is why complications and unique features of the surgeon and the patient must always be taken into account. It makes it easier to manage complex systems like robots if this data is accessible at the push of a button in the instruction phase, in the operating room or during training. Since this training system then acts as a kind of a digital tutor that’s always available on-site, we refer to mySebastian as an integrated training system. As part of our research project, we are now gradually adding new functions to where we will record the robot data right in the operating room. For this, we are already collaborating with several partners on interface concepts.

Another aspect of our development is to connect training with documentation and quality assurance. Hospitals collect a lot of data that is not being used for training because it is too complex. The question is which data can be used for pedagogical purposes, addressing beginner, intermediate and advanced competency levels. If educators were to join the conversation when it comes to documentation systems right from the start, all recorded data could also be used for training.

Korb: Apart from the aforementioned training concepts, I already suggested control systems for robot kinematics that could be used in spine surgery in previous publications. Today’s kinematic structures are attached to the operating table or the patient in one form or another and make great sense. I am certain they improve safety from a technical perspective. Patients and the motions of the robot would be no longer disconnected from one another. Many mistakes in the past were also a result of poor planning. That’s why I think great planning software would help improve robotic safety.

How extensively should budding physicians practice the use of robots?

Korb: The use of robotics must be an inherent part of advanced training and continuing education. One of the key problems today is that any surgeon with a medical license is allowed to use medical devices with no restrictions. Specialized surgical training courses are a great idea, which allow the application of trained "patterns" and not automatically all types of robotic surgery.

Another issue is that many devices are not just used by the surgeon, but are also applied by surgical assistants and technicians for example. That is why you also need interpersonal skills training. Much depends on future developments in this setting – we have already made several suggestions in mySebastian.

Great usability tends to make people forget about possible “worst-case” scenarios. How can this be remedied and how can you increase awareness?

Korb: All video and learning management systems rely on getting great content. We must be able to process errors and simulation cases and make them accessible as scenario-based training. Otherwise, the surgical community cannot learn from errors and mistakes. Unfortunately, this is frequently an issue in surgery. We must collaborate with surgeons and collect these types of "good" complication scenarios and systematically develop them as anonymized training cases.