How do you create a robot that’s part of a surgical team?

When it comes to developing surgical robots, there’s a shift underway from designing single-function machines to creating ones that are computationally intelligent, highly personalized and positioned to amplify judgment, reduce friction and give surgical teams in the operating room (OR) clearer, faster information when it matters most.

What is this poised to deliver? An alleviation of the mental and physical burden on surgical teams, greater potential for democratization of care, the delivery of insights that help clinicians hone their craft to promote more positive patient outcomes and more.

But, crucially, this is all possible only in collaboration with a human surgeon.

“A surgeon is an expert scientist and a caregiver. In terms of information processing, a surgeon could be thought of as leveraging deeply embodied digital and analog pathways to synthesize insights in real time in ways that no computer and no AI system today has even gotten close to,” says Neda Cvijetic, Senior Vice President, Global Head of Robotics and Digital R&D, at Johnson & Johnson MedTech.

That’s why, to enable the vast potential of the next era of surgical robotics, it’s essential to use design and engineering to ensure the robot and surgical staff are partners. Simply put: “Done right, a robot and enabling technologies can provide information at a critical moment in the procedure in a way that empowers the surgeon to make an even better judgment call,” says Cvijetic.

Johnson & Johnson MedTech has long been committed to making technology more human, care more adaptive and people more connected. Which is why—working together with surgeons, clinical teams and hospitals—the company is advancing and developing surgical technologies to help transform the surgical experience in harmony with clinical teams in the OR.

When it comes to designing robotic systems, it’s essential to understand that ORs are—and always have been—team environments. In a traditional OR, this team includes the surgeon and supporting staff and nurses. And the robot’s potential is to interact with that team through a variety of enhanced user senses.

“As it used to be, surgeons would do open surgery with their hands and could look directly at what they were doing. Then minimally invasive surgery was invented, and they could do all of that with minimally invasive instruments. But now with soft tissue robotics, technology is allowing surgeons to use enhanced visualization and resolution while preserving the benefits of minimally invasive surgery,” says Molly Flexman, Senior Director, Global Strategic Marketing, OTTAVA™, at Johnson & Johnson MedTech. Which is why it is critical to design surgical robotics with a deep understanding of how surgeons use their senses.

Take touch, for example. “If you think about the kind of motions that a surgeon makes to accomplish a procedure, the robotic system has to be incredibly dexterous,” says Nick Patronik, Senior Director, Robotics, at Johnson & Johnson MedTech. “It has to have a high degree of precision and control, and you need a sophisticated robotic design in order to deliver those motions with high fidelity.”

Additionally, it’s essential to study the actual workflows and dynamics in the OR. For example, research has shown that OR organizational factors¹, like slow turnover time, can lead to an increase in adverse events. Analyzing these workflows can uncover solutions that optimize outcomes.

“We work on understanding the unique needs of each workflow and person within that workflow,” Cvijetic notes. “Comprehending the experience of care teams can be transformational.”

Indeed, “a huge part of our role in designing surgical robotics is deeply understanding surgeons,” says Flexman. “That means understanding their pain points and day-to-day activities. Based on that, we explore what a future state could look like by bringing in new technologies and trends. But none of that will work if you don’t first understand their reality.”

Being highly attuned to design and function is critical, because without the right design, robots can be too complex to use and might create an extra burden for surgeons. For example, as Patronik explains, setting up ports and docking arms can determine the whole course of the surgery. If the ports and robot arms are positioned incorrectly—so that access becomes difficult, or so the arms collide or run into their joint limits, for example—the surgeon and team may face interruptions.

Conversely, a surgical robot needs to meet the complex requirements of a surgical procedure. “The surgeon needs to have the same control, dexterity and precision with the robotic instruments that they would have with their hands in an open procedure,” Patronik says. “So, there's a very high bar in terms of us providing that range of motion, precision and accuracy that surgeons expect.”

To that point, Patronik’s main goal for the systems he designs is to ensure the technology can be seamlessly integrated with the surgeon’s mindset, rather than asking the surgeon to adjust to a new technology. “That design consideration goes all the way from the design of the robotic hardware to the design of the algorithms that control the robotic hardware to the mechanical design of the instruments,” he says.

Space constraints in the OR can also impact how surgical teams work. Johnson & Johnson MedTech has taken this feedback and is innovating robotics architecture that creates space in the OR. And then take noise pollution, which has increased exponentially in ORs and hospitals in recent years and can lead to increased stress and impaired communication and concentration among the surgical team.² To combat this problem, the design team at Johnson & Johnson MedTech intentionally works with expert sound designers to create welcome, calming sounds to help make their robotic innovations feel approachable.

Another important way that robotic systems can embed with the surgical team is by providing them with ways to learn from their work and hone their craft. 

“When you think about sports, at the end of a game, the first thing every athlete does is go into the film room and review their footage to understand how they can do better next time,” says Flexman. “That’s what surgeons are looking for as well. With digital capabilities, not only do we have the film, but we have the technology to understand what happened during the surgery.  Surgeons can use that as learning material for teaching others and continuously improving their own practice.”

While surgical robot design isn’t focused on task autonomy yet, Cvijetic says that detailed imaging will be the next main advancement. 

“Before you can get to task automation, you need a thorough understanding of the scene,” she explains. “So, we’re working on augmenting what the surgeon sees and uncovering more of the unseen, such as hidden structures.  Can we help surgeons see these better? Can we help them analyze what they see in more detail? Can we give them a real-time, live view of things that they currently can only see from a preoperative image?”

Another opportunity is with advanced simulation and physical AI. Cvijetic notes how developing these technologies will impact both soft tissue and endoluminal robotics. By creating high-fidelity digital “twins” of a human and OR environment, these technologies create the potential for surgeons to create and practice personalized surgical plans before stepping into an OR, including testing potential variations in anatomy, patient positioning, imaging equipment and clinician workflows.

The mission at Johnson & Johnson MedTech is to improve the surgical experience for everyone: patients, surgeons and support teams. By improving the surgical experience—and ultimately the human experience—surgeons are equipped to deliver patients better outcomes.

“The last thing we want to do is develop another technology, put it in the OR and expect the surgical team to adapt to it,” says Patronik. “So, we maintain both a surgeon-centric and patient-centric mindset to reduce friction as they deliver care. That’s how we create huge wins for healthcare.”