'Exploring the social-technological gap in telesurgery: collaboration within distributed OR teams' - CSCW 2014
•
5 gefällt mir•1,205 views
My CSCW presentation titled 'Exploring the social-technological gap in telesurgery: Collaboration within distributed OR teams' Full paper can be found here: http://dl.acm.org/citation.cfm?id=2531602.2531717&coll=DL&dl=GUIDE&CFID=293488017&CFTOKEN=66434473
Empfohlen
Weitere ähnliche Inhalte
Ähnlich wie 'Exploring the social-technological gap in telesurgery: collaboration within distributed OR teams' - CSCW 2014
Ähnlich wie 'Exploring the social-technological gap in telesurgery: collaboration within distributed OR teams' - CSCW 2014 (7)
Kürzlich hochgeladen
Kürzlich hochgeladen (20)
'Exploring the social-technological gap in telesurgery: collaboration within distributed OR teams' - CSCW 2014
- 1. Exploring the social-technological gap in telesurgery: Collaboration within distributed OR teams Pieter Duysburgh Shirley A. Elprama Prof. dr. An Jacobs - CSCW 2014 / Baltimore 1
- 2. Location A Location B Source: Marescaus, J., Leroy, J., Rubino, F., et al. Transcontinental Robot-Assisted Remote Telesurgery: Feasibility, and potential 2 applications. Annals of Surgery 235, 4 (2002), 487-492.
- 3. ‘Telesurgery’ Distributed team Robot-assisted ‘by default’ Minimum of 2 surgeons 3
- 7. Roles in the operating room Minimal invasive surgery Anesthetist: pharmacologically induces and monitors the patients Surgeon: operates on patients Circulating nurse: Hands tools to scrub nurse / assistant and works in non-sterile area Assistant: helps surgeon (e.g. placing staples, holding tissue) Scrub nurse: Helps surgeon / assistant and hands them tools 8
- 10. 11
- 11. ‘Telesurgery’ 12
- 12. Research questions What are the current collaborative practices in robotassisted surgery? What can we learn from this with regard to OR collaboration in (robot-assisted) telesurgery? 13
- 13. Proxy technology assessment (PTA) PTA is “a method for emulating practices with future technologies and applications by confronting selected user groups with existing similar tools and applications” (Pierson et al., 2006) 14
- 14. Interviews and observations 7 interviews 14 surgeries observed in 4 hospitals 5 minimal invasive surgeries 9 robot-assisted surgeries 8 verification interviews 5 surgeons 3 scrub nurses
- 15. Collaborative challenges in telesurgery 1. 2. 3. 4. 5. Procedural preferences of surgeons Trust between remote and local surgeon Keeping an overview of the OR Mediated communication Incremental effort increasement 16
- 16. Collaborative challenges in telesurgery 1. 2. 3. 4. 5. Procedural preferences of surgeons Trust between remote and local surgeon Keeping an overview of the OR Mediated communication Incremental effort increasement 17
- 17. 1. Procedural preferences of surgeons Close working relationships No knowledge of prefered approach to medical problem Increased operating time “I always know what they are going to think or say” – Scrub nurse 19/02/2 “It would be exhausting [to have a new team composition each day]. You would have to ask [for instruments], while now we are used to each other, the nurse knows what we are doing, [she] gives the default instruments and has prepared the things that you need. You just have to reach out with your hand without [verbally] asking for it. And this will be difficult if you would have a new team or changing teams” - Surgeon 18
- 18. 2. Trust between surgeons The presence of two equivalent surgeons challenges the hierarchy in the OR The surgeons have to rely on each other skills, e.g. for trocar placement Surgical interventions are ‘forwarded’ and hence more likely to be complicated 19
- 19. 3. Keeping an overview of the OR Surgeons frequently step away from the robot console Contextual sound amplification Is disturbing rather than supportive New coping strategies will have to be developed “When doing open surgery or laparoscopy, you can see the monitors of the anesthetist, you can see who is entering and leaving the OR. (...) You can tell if there is a problem or a discussion. You have a good overview of what is going on. But when sitting at the controller, you’re unable to see things like that, you cannot even see the patient.” - Surgeon 20
- 20. Wrapping up Wrapping up OR team should get acquainted with the procedural preferences of the remote surgeon Clear agreements between the collaborating surgeons Provide alternatives for current coping strategies 21
- 21. Discussion Other types of real-time remote collaborations in surgery Teleconsultation Telementoring Telestration Distributed OR teams Fixed teams? Structural collaborations? Complemented with face-to-face encounters? 22
Hinweis der Redaktion
- Let me start by showing you these pictures of what has called ‘Operation Lindberg’. They were made in 2001 and what you see is the first actual remote surgical or telesurgery operation, done between New York City and Strasbourgh and performed on a 68 year old woman over a distance of 7000 kilometer. It was done by dokter Marescaux and his team: I show you this, to illustrate that the technical feasibility of telesurgery has been shown over 13 years, but today telesurgery is not a thing that is happening. This presentation will look at the challenges for telesurgery from the perspective of the OR team. In the literature, the challenges for telesurgery are mainly understood als techonological, legal or financial, but I will try to argue that there are also some important challenges with regard to collaboration.
- Telesurgery as we understand it for the purpose of the paperThe surgeon is remote, ad hoc relationship
- Telesurgery is being looked into because it potentially has some clear advantages: It can bring the expertise of a highly specialized and highly skilled surgeons to virtually any OR in the world, or to that OR where the surgeons skills are most required. As such, highly specialized interventions would no longer require the surgeon or patient to travel. “1) providing surgical care to patients who would otherwise go untreated;2) improving the overall quality of care by enabling expert surgeons to proliferate their skills more effectively;3) reducing the cost by eliminating unnecessary patient and surgeon travel.” (Butner & Ghodoussi, 2003, p. 818) GO TO NEXT SLIDE
- These are the thresholds that Legel challenges mainly have to do with accountability: who will be held responsabile in case of a medical error?Technical challenges mainly have to do with video stream latencyWe have actually examined this technical issue ourselves in a series of experiments
- http://weinterrupt.com/wp-content/uploads/operating_room.jpghttp://digital.ni.com/public.nsf/$CXIV/ATTACH-AEEE-864JLV/$FILE/Communication%20Error%20Occured.jpghttp://danielglasser.me/wp-content/uploads/2012/03/Computer-Code.jpghttp://www.legaladvantagehrsolutions.com/images/legalimage1.jpg
- A. Kumcu, S. Elprama, L. Vermeulen, P. Duysburgh, L. Platiša, Y. Van Nieuwenhove, N. Van De Winkel, A. Jacobs, J. Van Looy, W. Philips, "Effect of video latency on performance and subjective experience in laparoscopic surgery", In Medical Image Perception Conference XV, Washington D.C., USA, August 14-26, 2013. [bib]Latency: between the movement you make and the feedbacj you receive on the screen
- Collaborative aspect is often ignored/overseen and we think it’s important to considerThe OR team is usually a very tight team.There is a clear hierarchy: everyone know what he/she has to do. Normally you don’t have to ask explicitlyVery coordinated working team.http://digital.ni.com/public.nsf/$CXIV/ATTACH-AEEE-864JLV/$FILE/Communication%20Error%20Occured.jpghttp://danielglasser.me/wp-content/uploads/2012/03/Computer-Code.jpghttp://www.legaladvantagehrsolutions.com/images/legalimage1.jpg
- As you can see, all these pictures were taken during the observations. First, there was open surgeryThen MISNotice how everyone stands very close togetherSnellerer door heenVoordeel: less scarring en quicker recoveryTrocar!!
- RSNotice distance surgeon and patientAdvantages: no tremor, 3D vision, can change the scale of movement 3/1 scaleDisadvantages: no tactile feedback
- The surgeon is remote, ad hoc relationship
- A close examination and good understanding of the social-technical gap in robot-assisted surgery can steer future developments of telesurgery techology or help explaining why it remains a rare practice
- Problem: telesurgery is very rareThere is no telesurgery being done, but we want to understand how team practices would work. So what is the closest technology to telesurgery? They use the same technology, the surgeon is a bit removed. Understanding team dynamics in such a location will help when a team is remote.TO DO: uitschrijven en quote nietoplezen
- Limitations: Ethnograpic approach, limited number of participantsHigh time pressure during interviewsNo observation of any ‘real’ telesurgery
- In this presentation I will only explain the first three challenges, due to time limits. The other we can discuss after the presentation or you can read about in the paper
- Scrub nurseReally close working relationship with surgeon work together with someone they know lessCommunication usually is via scrub nurseCirculating nurse*
- Two surgeons share the same position in the hierarchy of the or teamNow, when surgeons work togetherOne of them is an assistant, who has to take directions from the surgeonOr the surgeons have another specialization;
- -- come back to question