You are on page 1of 8

Journal of Innovation in Electronics and Communication Engineering

Role of Human Factors in Establishing an Intelligent

Operating Theatre
Rabinder Henry1 , Barbara Deml2

Jampot Photonics, Pune, India

Otto-Von Guericke University, Magdeburg, Germany

Abstract - The proposed work is review of the issues of

human factors and ergonomics in designing an intelligent
operating theatre (IOT) which incorporates robotics
systems for operation, patient monitoring, data storage
and communication systems. A detailed discussion on
setting up a theatre which considers factors influencing
the automated systems and human interactions. The study
describes using top down approach for analyzing the
human factors (HF) in operation procedures, surgical tool
movement and handling, patient monitoring systems, data
collection system, communication systems using multiple
video and audio channels required to co-ordinate the
process between humans and automated systems. The
theatre design is reviewed to include the HF to be
considered with respect to the limitation of automated
systems and requirement of patients. An ideal intelligent
operating theatre focused on neurosurgery is envisioned
wherein the task is uniformly divided between the
automated systems and humans to improve the quality,
precision, patient safety and mainly to reduce the medical
error to enhance the quality of the medicine and operation.
Keywords -Intelligent operating theatre, human factors
in robotics in surgery, human-machine interaction.

1.1 Intelligent Operating Theatre:

IOT is a network of robot for surgery which is voice
or video controlled for minimal invasive surgery by
interfacing advanced radiological imaging systems with
operating room, catherization laboratory, intensive care
unit and clinical and pathological laboratory on the same
floor or within same space. Such a design allows the
networking and intelligence to control and monitor entire
patient care process in an innovative procedure [5]. The
intelligence along floor allows easily flow of patient
information between hospital information systems,
physicians; surgical team and patient care units. The
information flow allows greater flexibility in operational
procedure, real time decisions which allow innovative
surgical techniques while at the same time providing the
patient with proper cure, minimal pain and discomfort. IOT
provides single integrated facility for neurological,
laparoscopies, tele-surgery and tele-medicine. IOTs were
initially developed for neurological surgery considering
rapid pace, quick response required during the procedure
and interfacing imaging modalities like magnetic resonance
imaging (MRI) and Computer Tomogrphy (CT) requirement
in the operating theatre.

The rapid technological developments in computing,
communication and controlling have led to application of
automation and robotics in medicine and not just restricted
to surgical instruments. Digitization of bio-medical
instruments for diagnosis, therapy, monitoring and surgery
have made interface with computer and interconnectivity
within and with networks easier. This has led to integrated
IOT which is automated in such a way that the instruments
and robot in surgery could be the advanced vision, hands
and brain of the surgeon enabling improved precision in
intraoperative procedures and better environment for the
patients [4].

Vol. 5(2), July Dec 2015@ ISSN 2249-9946

Figure 1. Intelligent Operating Theatre using open


Journal of Innovation in Electronics and Communication Engineering

The two basic limitations in neurosurgery are the
quick response time of the operating team and interruption
during intraoperative MRI imaging of the guidance team
.Refer Figure 1 of a simple intelligent operating theatre.
This has been overcome by integrating the Open MRI
and guidance equipment with Surgery Information systems
[4], [5]. The IOT allows automating and assisting the three
main components of surgery- the surgeon, the medium
and the patient. The media are the mechanical, visual,
auditory, surgical tools or instruments through which the
surgeon interacts with patient's Area of Interest (AOI).
The complexity of the interaction determines the
possibilities and limitation in terms of automation and
monitoring patient's AOI. In an IOT the challenges are
even more complex considering the HF issues and design
aspects of the instruments, surgery tools and sensor
systems which are required to respond in real time
stochastic situations which are crucial for the surgeon and
the safety of the patient.

integrated approach of human interaction with individual

automated system and the system as a whole. HF issues
and ergonomics are the most important factors that
determine the applicability and usability of the autonomous
systems for humans operations as well as the clinical patient
requirements and necessities [3].
HF role in designing an automated system or robot
for surgery is limited by institutional and psychological
barrier for use of automation in health care especially in
surgery. The implementation of the robot for particular
surgery is determined by the necessity for automation and
by the limitation realized by the surgeon during the surgery.
The selected robot should replace or support an existing
procedure without disrupting the regular routine. It should
be able to coordinate with the team and at the hospital
level information system management. Early days of
technological developments robotics were restricted
towards minimal invasive surgery (MIS) using laparoscopy.

1.2 Robotics in Operating Theatre:

Robot was initially used for laparoscopic surgery
which requires performing repetitive actions; vibration less
manipulation using voice control where in the system was
operated by the chief surgeon [2]. In recent developments
autonomous robots have replaced or work in tandem with
Robots which assist in surgery. Application of robotics
has become more specialized depending on the requirement
and technological availability. Miniaturization of control
and intelligent units and devices using Micro Electro
Mechanical systems (MEMS) have enabled integration of
robots with multiple degrees of freedom and complexity to
be integrated in surgery and patient monitoring systems.
The robotic applications can be summarized as below

Fig. 2 Intelligent Operating Theatre For Neurosurgery

Robotized surgery

Robotized motor coordination analysis and therapy

Robot-assisted mental, cognitive and social therapy

Robotized patient monitoring systems

The main advantages of using robots were no

fatigue, stability and can be voice- controlled by the
surgeon [7]. Using robots for MIS imposed additional
safety issues, visual and motor constraints on part of the
surgeon since the surgeon had to consciously monitor
and control the operation of the robot rather than
concentrate on the surgery. The location of AOI, constant
rotation of display space and operative site restricted the
movement of the surgeon. This was overcome by placing
the camera and the surgeon along the same position with
respect to the AOI. As the use of robots have increased in
all disciplines of general surgery, neurosurgery, pediatrics,
orthopedics, urology, ophthalmology and cardiac surgery

These form the basic units of IOT along with imaging

and communication modalities. The proper integration of
Robots along with workspace design enables an
autonomous operating system with high accuracy, flexibility
and patient care [6].
1.3 Human factors in IOT
HF issues in an IOT have to be analyzed as an

Vol. 5(2), July Dec 2015@ ISSN 2249-9946

Journal of Innovation in Electronics and Communication Engineering

the HF issues to be considered varies as per each
application and utility. In all robotics applications the
surgeon's behavior in an IOT, movement and response in
operating room, the innovative channels of communication
and control that determine the focus shift of the surgeon
and the process by which the surgeon and operating room
display and relay images and other clinical information
determine the improvement in the safety and performance
of the operation procedure. Detailed analyses of the
surgeon role in operating theatre, surgery tool movement,
surgeons minimal control of robots and automated systems,
cognitive behavior of surgeon in a team , information flow
path between surgeon ,team and instruments have to
analyzed and considered in detail in planning the location
and construction of the of an IOT [9].

shift of the surgeon. The control screen is a multiple display

system along the wall of the operation theatre which mobile
control settings. The mobile control setting allows the
sterile nurses, non-sterile nurses, anesthetist and surgeon
to have complete data, images and other monitoring data
on a single plane [11]. The control screen is an interactive
system which enables centralized control of the operation
procedure, resources in the operation room and the medical
staff by the chief surgeon who is performing the operation.
The surgeon can interact with the control screen using
hand gestures, control the instruments, co-ordinate the
operation by interacting with the instruments and staff
using voice control.
1.6 Intelligent Operating Space using voice control

1.4 HF issues of IOT for Neurosurgery

The main goal of automating the operating theatre is
to provide intelligent, collaborative, intuitive operating
environment which minimizes surgeon's shift focus by
minimizing the focus spatial offset and the movement
spatial offset. The proposed hypothetical IOT combines
certain existing systems along with new innovative robotic
applications in terms of information connectivity and
patient monitoring systems. The Figure 2 gives the layout
of the IOT specialized for neurosurgery.
1.5 Intelligent display system
The integral part of the IOT are three display systems
1) the integrated imaging display system 2) motion capture
system and 3) control screen. The multimodal imaging
system includes MRI, CT, EEG and X-ray which are required
for neurosurgery diagnosis and surgery guidance. Such a
system enables the surgeon to have instant images and
electrical readings on a single integrated display. Integrated
display system with multiple displays can provide better
solution by minimizing the time required to move the
surgeons head in different directions. The integrated
operating theatre is also equipped with video recognition
and audio control system to enable motion capture of the
surgeon and others assisting in the operation procedure.
The audio-visual motion capture system allows the IOT to
detect surgeon's head direction movement , hand
movement and the intelligent control software can predict
the required image to be projected from MRI or CT of the
patient. This reduces the focus shift and the spatial shift
of the surgeon .Such a surgeon assisting system tracks
the motion and the point of focus of the surgeon and
displays the required image thereby avoiding the spatial

Vol. 5(2), July Dec 2015@ ISSN 2249-9946

Fig. 3 Intelligent interactive hand gesture control [10]

Apart from the motion capture system the intelligence
of the operating room space is improved by adding multiple
audio sensors .The main surgeon along with the assistants
and the nurses are provided with microphones which allows
them to interact with each other during operation. The wall
mounted steerable camera projection system allows coordinate tracking of the medical staff within the operating
space. Some of the medical equipments and medical records
can be displayed on the multimodal display system using
verbal commands by the surgeon. A set up of commands
unique to the surgeon, assistants and nurses in hierarchical
mode allows for individual to access the required data
without disturbing the flow of operation to be displayed
[12]. The human resource present in the room is split into
3 tier hierarchy. The chief surgeon and respective
commands and co-ordination is the level 1.The second
level of voice control is for the anesthetist and the display
system for the anesthetic equipment which is integrated
with the main control panel. The third level of voice control
is for the sterile and non-sterile nurses to interact with the

Journal of Innovation in Electronics and Communication Engineering

monitoring equipment and the surgeon. Such a hierarchical
voice control and commands coordinated by the audio
algorithms allows the systematic co-ordination the medical
staff which minimizes spatial movement within operation
room and improves efficiency by conserving time. Voice
commands are integrated with the hand gestures to evolve
proper co-ordination of the operation of medical
instruments which are monitoring the patient's conditions
like blood pressure, temperature and ventilator.
1.7 Intelligent Operating Space using hand gestures

controlled by the sterile nurse. Such interface minimizes

the movement of the sterile nurses and increases the
mobility of the surgical bed with precision within the
operation space. The gesture control allows the surgeon
to improve the concentration on the operation without
being disturbed by the movement of the nurses. Hand
gesture based control along with voice commands are
extended to tele-robotic surgery. Figure 4 gives the detailed
flow of the visual and voice control in an IOT. The control
system consists of four subsystems 1) pan -tilt camera
across the operation room to focus on the movement of
the individuals to map the work space utilization, 2) hand
gesture interaction haptic sensors within the gloves of
the surgeon and assistants ,3)posture detection camera
focused on the surgeon ,4) microphones of the surgeon
and assistants ,all the sensors are interfaced with the
controller which performs the behavior analysis and
extracts the required focus shifts to co-ordinate the action
in the operating room. Posture detection cameras detect
the head movement, torso position and body orientation
of the surgeon in a 3 dimensional space. This positional
information is used to calculate the facial focus offset and
movement spatial offset to determine the attention shift.
The extracted focus shift is projected back to the control
screen to stimulate and remind the real time re-action to be
taken by the surgeon.
1.8 Intelligent Operating Space using interactive MRI

Figure 4 : Intelligent Operating Theatre Gesture voice

The present small camera and development in tactilesensors allows controlling the medical instruments, display
systems and other hospital resources through networking
using hand gestures with the interactive High Definition
Display Systems. The surgeon's hands are attached to
hepatic sensors which allow the surgeon to pick and drop
controls via the interactive screen. Such an interactive
control reduces the spatial movement of the surgeon and
at the same time minimizes the time required to perform
different procedures involved in surgery [10]. This hand
gesture based control combined with audio control allows
more flexibility for the surgeon. It increases the speed of
performance and also multi-nodal interaction of the surgeon
by allowing audio control of instruments at the same time
performing the operation. The hand gesture based control
is extended to control the patients surgical bed .The present
mechatronic surgical bed is interfaced with the centralized
control panel which can 'be both voice and gesture

Vol. 5(2), July Dec 2015@ ISSN 2249-9946

The most important imaging device for neurosurgery

is the MRI .In IOT the rest of the equipment are aligned
and placed in the operating space in such a manner that
they are compatible with magnetic field of the MRI. The
MRI is interfaced with multiple channel video broadcasting
system and image recoding system with the IOT space to
enable real time consultation and decision making while
the consultant surgeon remains at a remote venue without
entering the IOT [4]. The interface with HIS enables data
communication in real time. Intraoperative imaging using
MRI, CT or X-ray provides the flexibility to use multimodal
imaging system within IOT space. Such a sophisticated
multi modal imaging system provides the surgeon with
required information to modify the surgical procedure
especially in a neurosurgery which requires precise
resection of the brain tumors or lesions. Interfacing of
other surgical devices like fluoroscopy , C-arm, surgical
microscope , CT to the centralized control system allows
easy switch and display of images and data on a single
control panel thereby reducing the time required for the
surgeon and other staff. Since a neurosurgery is composed

Journal of Innovation in Electronics and Communication Engineering

of smaller module which are interrelated in a complex step,
it vital to evaluate each and every step in proper analysis
to deduce the medical error that may occur during the
surgery. Complete interactive projection along with
broadcasting and recording enable to concur with the
method followed. The multichannel video recording arises
out the limitation posed by the magnetic field and
electromagnetic interference from the MRI. The cameras
above the surgical bed and surgical space allow monitoring
and recording of the complete procedure. The microscope
which is indispensible in a neurosurgery is multiplexed
with projected image to display along with the imaging
device's images. The video data which are recorded through
multiple channels are multiplexed and stored in the control
panel. The live recorded data is either broadcast within the
intra hospital network or for tele-surgery over the internet
to a remote location. The ceiling mounted cameras allow
capturing the motion of the medical staff and allows for
post analysis of the surgery. The additional advantage of
multiple channels recording is that it enables the
pathological laboratory and other laboratories to be
networked in real time which enables faster decision making
of the staff in charge instead of waiting for a request to be
placed by the surgeon in the theatre. The multi channel
video recording offers insight in to detecting errors during
intraoperative procedure. This enables post surgery
analysis solution that can be corrected in the subsequent
operating procedures.
1.9 Intelligent surgical instruments for Neurosurgery
The robots specific to neurosurgery have been in
application since 1987 .Today many technological
advanced robotic system for neurosurgery are available
but however they have some limitations. Since they use
intraoperative imaging system to position specific target
location on the brain of the patient in real time , the delays
in the procedure or disturbances in the operating room
occur. Robotic system with multiple degrees of freedom
enables precise location of specific point on the brain of
the patient. The robotic system allows multiple
configurations through wired and wireless connection
enabling tele-control as well as localized robot control by
the surgeon. The robot is equipped with feedback sensors,
end effectors, mini cameras and distance measuring system
for mapping the specific location. Since multimodal image
data is readily available it is easy for fuse of image from
different modalities like MRI and CT which enables the
robot processor to locate distance within microns range.
The end effectors consist of probe or endoscope or

Vol. 5(2), July Dec 2015@ ISSN 2249-9946

retractors in separate arm which enables simultaneous use

of end instruments thereby reducing the number of tools
required to perform simple operation procedure [13]. The
main advantages of using robotic system for neurosurgery
are precise micro surgical modalities, increased accuracy
and precision compared to physical work of surgeon,
access to very small apertures on the brain compared to
deep cut in a manual operation, high processing power of
the robot enables complex data calculation and infer
specific location of the operation corridor. This is especially
crucial for image guided microsurgery. The most important
advantage of using robot based drilling or insertion or
tissue handling or suture performance is that robot is
extremely stable in performing such a task there by negating
the physiological movement of surgeon's hand or body
parts which normally affect the delicate tissues of brain
[14]. A hypothetical Neuroarm type robot envisioned for
the IOT can be interfaced with the main controller. The
display system of the robotic arm is interfaced with main
control display to enable the surgeon to have complete
control over the movement of the operation of the robot.
Advanced artificial intelligence can only be hypothetically
stated which may enable automated operation of the robot
considering the limitations offered by the neurosurgery
and intuitive ability required by the surgeon which is still
difficult to be replaced by programs. The neuro arm is
equipped with 2 arms of 7 degrees of freedom to hold
surgical tools while the 3rd arm is loaded with multiple
cameras to provide 3 dimensional stereoscopic view of
AOI. Such an arrangement enables the robot to perform
biopsy, microdissection, thermocoagulation, blunt
dissection, grasping of tissue, cauterizing, manipulation
of a retractor, tool cleaning, fine suturing, suction,
microscissors, needle drivers, and bipolar forceps with 1000
fold precision compared to the performance done physically
by a surgeon. Since all the tools are equipped with haptic
forced feedback sensors system it minimizes medical errors
by recording the performance and correcting the same
during the course of action. The robotic camera along
with MRI images provide excellent accuracy and precision
for the surgeon to perform the particular procedure in a
small corridor. The nueroram enhances the quality of
operations through its special safety features. Fail safe
switches enable the robotic arm to negate accidental
movements of the patient or the surgeon or disturbances
which may occur during the operation procedure. Since
the neuro arm come with simulator it enables to pre-plan
the entire surgical process with an in-built redundancy
plans and safety actions including the surgical boundaries

Journal of Innovation in Electronics and Communication Engineering

and limitations. Incorporating an expert software system
may be the initial step in totally automating the functionality
of neuroarm like robotics system. Expert system will provide
the necessary intelligence to robotics to predict the future
action of the surgeon which will enable the robot to be
prepared with possible actions.
1.10 Intelligent Anaethesitic equipment for
Important component of surgical theatre is the
ansethesistic equipment which controls the patient's state
during the period of surgery. In an intelligent operating
environment it is advantageous to have Digital Anaethesitic
equipment which can be interfaced with other tools in the
surgical space. The three main components are instruments
to measure neuromuscular blockade, depth anesthesia and
analgesia. The typical equipment are replaced by intelligent
systems which can assess the depth of anaesthesia by
using auditory evoked potential, heart rate and blood
pressure.Using a wavelet algorithm the collected data is
fed to a fuzzy logic based self learning system which
classifies the depth of anaesthesia [14]. Based on the
classification, the Target Control Infusion system can
deliver the required medication automatically. Such a
system improves the performance of the anaesthesist in
operation procedure by reducing the time for adjustments
and also improves the speed of the operationprocedure.
Such equipment interfaced with the control panel to provide
complete set of data for surgeon.
Though hypothetically proposed model is
combination of existing and futuristic medical system the
HF issues are more complex and complicated considering
completely automated intelligent operating theatre. The
IOT has improved the technical performance in terms of
engineering precision which may result in unexpected
incidents and new forms of medical errors. In IOT space
wherein all the equipment are interfaced digitally to
centralized system the amount of technical errors can be
high in proportion to more intelligent software and
hardware. Real extent effects of such errors are to be
inferred only through physical implementation of such a
system. With introduction of technology in operating space
the roles and responsibilities of the medical staff tends to
change with improvisation of technology [15]. It is of
ultimate importance to train the medical staff in the updated
technology and engineering. Introduction of audio, video
and gesture control may lead to a new kind of

Vol. 5(2), July Dec 2015@ ISSN 2249-9946

communication model within the working group. The voice

commands and gesture are to be role specific so that
mismanagement of equipments may be avoided which may
prove to be detrimental to the safety and security of the
patient.Though the technology improves the rate of
operation procedure it may result in unexpected
communication loss since most of the procedure are done
through robotic system which minimizes the direct
communication within the group.
2.1 Human Performance Efficiency in IOT environment
In an intelligent and completely automated
environment the efficiency of the medical staff is largely
determined by the cognitive skills to adapt, improvise and
innovate while working with digitally processed data and
machines.This can be overcome by using suitable
simulators that encompass all components of the IOT and
also has enough processing ability to simulate real time
situations. To work with large amount of medical data and
instruments it is required to develop a set of rules and
guidelines which enable the medical staff to perform
intuitive and efficient interaction within an intelligent
environment [16]. The simulator must include simple
navigational techniques and easy access methods within
an intelligent space which will enable the human resources
to navigate in a digital space and equipments in real time
scenario. The degree of presence in a highly networked
environment may also influence the performance of the
surgeon and other medical staff. The individual
performance within stipulated tasks in a hierarchical
procedure will determine the overall performance of the
entire system. In a traditional surgery wherein the surgeon
required to use multiple tools and equipment manually may
result in different kind of stress and fatigue for the surgeon.
Replacing these type of muscoskeletal actions of surgeons
with the neuroarm type of robotic system increases of the
efficiency of the surgeon.
Intelligent environment may alienate the patient from
the surgeon and the support medical staff in an operating
theatre which is technically advanced and functions with
the support automated machines and robotics system [3].
It is important to get the consent of the patient by explaining
the technology being utilized to familiarize the patient with
environment before being operated in an intelligent theatre.
The human presence and behavior plays a crucial role in

Journal of Innovation in Electronics and Communication Engineering

patient psychology while being placed in such an operation
3.1 Ergonomics in designing an IOT
The proper use of space and planning of the
placement of equipment is important to increase the
mobility and accesses ability of the instruments. An
efficient design is required in an IOT for placement of audio
and video capture system in-order to minimize the noise in
the operating space. The equipment should be mobile in
order to re-arrange the instruments as per requirements
[2]. Though standards are available for setting up operation
room they are not sufficient enough to include
technological advancements. Considering the amount of
cables and wiring required across the operation area proper
planning is required to provide free space in the working
environment. An IOT with tele-surgery requires additional
wireless equipments which may be sensitive to
electromagnetic interference. Placing additiona equipments
like robotics arm may strain the mobility of the surgical bed
as well as the medical staff. Noise can be major factor in
using multiple robotics system which has to fixed by using
appropriate noise filters. Another important factor which
may affect the surgeon and medical staff may be multiple
illuminated screens which may have huge effect on the
surgeons concentration. Work space required for robotic
systems and tracks or railings required for the locomotion
of the machines are to be fixed in the ceiling so that floor of
the surgical area is free. Computer Aided Design of the floor
area may provide an optimal solution for an IOT.
3.2 HF issues human computer interfaces in an IOT
In an IOT there is huge amount of interfaces between
devices and computer. An IOT numbers of interfaces of
subsystem which are interfaced the main control system.
The audio interface, video control interface, MRI interface,
Anaesthesitic system interface, patient monitoring system
interface, robotic arm interface, tele-surgery interface and
surgical bed interface are few of the components in an
automated environment. The load on such an interfaced
network is very high, requiring proper flow of information
from multiple sub-systems simultaneously. This poses high
requirement on the processing ability of the control
software as well as the data storage system for storing
surgical and patient data. Such a complex networked
environment poses huge risk on proper functioning of the
operation procedure. Malfunctioning of even a single
interface may severely affect the medical staff performance
as well as the safety and security of the patient. Medical

Vol. 5(2), July Dec 2015@ ISSN 2249-9946

hazard posed by such an intelligent environment is very

high due to failure of software or interfaces. Patient
monitoring systems which collect clinical data from the
patient provide real time status for the surgeon to decide
the progress of the surgical operation. When a robotic
system or an automated instrument are interfaced with
patient monitoring system the risk of medical error increases
based on the quality and response time of the interface.
This can be eliminated by updating the simulator during
the course of the IOT which may deduce such an error.
This will enable the medical staff to scout for redundant
solution in case of failures of interface or software. Since
each physical parameter of the patient is measured with
separate sensors and instruments its vital that the
information is collected sequentially and parallely.
Integrated control of the instruments in an IOT decreases
such medical errors in processing patient data. The surgeon
is required to directly interact with imaging system and
surgical robot simultaneously while performing the
operational procedure wherein the computer interfaces with
surgical equipments should allow easy navigation around
the patient's AOI. The human computer interface issues in
medical care are complicated to considered specifically for
an IOT. IOT though is in existence with certain unique
intelligence specific to control; complete IOT specific to
particular surgery is still futuristic.
A total intelligent operating theatre which not only
assists the surgeon but can directly control the space,
movement of medical staff, equipment, interfaces, patient
care and safety is extremely difficult to attain since the
presence of human is still required to navigate and control
the intelligent environment. Though robotic and intelligent
systems can replace certain modalities it is not possible
to fully automate the complete process of surgery like in a
manufacturing industry. Though the proposed system
offers immense improvement in technical and engineering
aspect of the operation, the cognitive and emotional
content of the medical healthcare is difficult to be replaced
completely by automation. The proposed work describes
the human assistance offered through audio and video
control , automated robotics arm for surgery, video
broadcasting of MRI and quality of interface required to
realize such an human computer interface. Human factors
analysis offers a useful insight to the extent automation is
possible in surgery. Further detailed study is required to
understand the impact of artificial intelligence and highly
automated machines on the human performance.

Journal of Innovation in Electronics and Communication Engineering

Thanking Professor Babara Demul for giving a free
hand in choosing a topic of interest which helped to
understand the subject in a personalized point of view.
Also thank my amma (mom) without whom this phase of
learning in my life wouldn't have been possible.

" A history of robots: from science Wction to surgical

robotics)," Journal of Robotics Surgery,Volume 1,
Springer 2007,pp113-118..

C. J. Kaufman, Rocky Mountain Research Lab.,

Boulder, CO, private communication, May 1995.


J. V. Sutherland, W. J. Van den Heuvel, T. Ganous ,

M. M. Burton, A. Kumar, Towards an Intelligent
Hospital Environment: Adaptive Workflow in the OR
of the Future, Stud Health Technol Inform.118
pp,:278-312, 2005






Takashi Suzuki, Kitaro Yoshimitsu, Yoshihiro

Muragaki1, Hiroshi Iseki, "Intelligent Operating
Theatre: Technical Details for information
broadcasting and Incident detect systems," i n
Journal of Biomedical Engineering, 2012, February
Pascale Carayon, "Handbook of Human Factors and
Ergonomics in Health Care and Patient Safety,"
Lawrence Erabum Associates, Mahwah, New Jersey,
2007, pp. 411-423.
E. Broadbent, R. Stafford and B. MacDonald,
"Acceptance of Healthcare Robots for the Older
Population: Review and Future Directions,"
International Journal of Social Robotics Volume 1,
Number 4 , Springer, 2009,319-330.
Iseki.H et al, " Intelligent Operating Theatre using
intraoperative open-MRI," Journal of Japan Society
of Magnetic Resonance in Medicine,Volume 4,
Number 3, 2005, pp.129-136.
Joanne Pransky, (2001),"An intelligent operating
room of the future - an interview with the University
ofCalifornia Los Angeles Medical Center", Industrial
Robot: An International Journal, Vol. 28,2001 pp. 376
- 382.


Garnette R. Sutherland. Miller, " The Vision of

RoboticNeurosurgery ," Congress Quarterly
,Congress of neurological surgeons magazine,
Volume 12, Number 2 Spring 2011,pp.16-17


N. G. Hockstein, C. G. Gourin, R. A. Faust, D. J. Terris

Vol. 5(2), July Dec 2015@ ISSN 2249-9946

[10] Wachs J.P., Gaze, "Posture and Gesture Recognition

to Minimize Focus Shifts for Intelligent Operating
Rooms in a Collaborative Support System" ,
International Journal of Computers Communications
& Control, ISSN 1841-9836, 5(1):106-124, 2010
[11] Thomas Riisgaard Hansen , "Focus shift analysis in
the operating theatre," article in Magzine.
[12] S. Chen, Mynatt, E.D," Transforming Graphical
Interfaces Into Auditory Interfaces for Blind Users,"
Human-Computer Interaction, Volume 12,pp,7-45
[13] Spicer MA, van Velsen M, Caffrey JP, Apuzzo ML ,
"Virtual reality neurosurgery: a simulator blueprint",
Neurosurgery magazine , Article ,Volume 54(4)
,2004,pp 783-797.

Nathoo, Narendra et al, "In Touch with Robotics:

Neurosurgery for the Future," ", Neurosurgery
magazine, Article, Volume 56(3),March 2005,pp 421.

[15] Intelligent computer-based systems for anaesthesia

control in hospital operating rooms"D. A. Linkens
(Department of Automatic Control and Systems
Engineering University of Sheffield, Sheffield S1 3JD,
[16] Kay M. Stanney, Ronald R. Mourant,Robert S.
Kennedy, "Human Factors Issues in Virtual
Environments: A Review of the Literature," Presence
Magazine, Volume 7,No.4,MIT Press, pp.327-357,