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Objective: Robotic assistance during surgery has been shown to be a useful resource to both augment the surgical skills
of the surgeon through tele-operation, and to assist the surgeon handling the surgical instruments to the surgeon, similar
to a surgical tech. We evaluated the performance and effect of a gesture driven surgical robotic nurse in the context of
economy of movements, during an abdominal incision and closure exercise with a simulator.
Methods: A longitudinal midline incision (100 mm) was performed on the simulated abdominal wall to enter the
peritoneal cavity without damaging the internal organs. The wound was then closed using a blunt needle ensuring that no
tissue is caught up by the suture material. All the instruments required to complete this task were delivered by a robotic
surgical manipulator directly to the surgeon. The instruments were requested through voice and gesture recognition. The
robotic system used a low end range sensor camera to extract the hand poses and for recognizing the gestures. The
instruments were delivered to the vicinity of the patient, at chest height and at a reachable distance to the surgeon. Task
performance measures for each of three abdominal incision and closure exercises were measured and compared to a
human scrub nurse instrument delivery action. Picking instrument position variance, completion time and trajectory of
the hand were recorded for further analysis.
Results: The variance of the position of the robotic tip when delivering the surgical instrument is compared to the same
position when a human delivers the instrument. The variance was found to be 88.86% smaller compared to the human
delivery group. The mean task completion time to complete the surgical exercise was 162.7± 10.1 secs for the human
assistant and 191.6± 3.3 secs (P<.01) when using the robotic standard display group.
Conclusion: Multimodal robotic scrub nurse assistant improves the surgical procedure by reducing the number of
movements (lower variance in the picking position). The variance of the picking point is closely related to the concept of
economy of movements in the operating room. Improving the effectiveness of the operating room can potentially
enhance the safety of surgical interventions without affecting the performance time.
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