Robotic scrub nurse to anticipate surgical instruments based on real-time laparoscopic video analysis

Abstract

Machine learning and robotics technologies are increasingly being used in the healthcare domain to improve the quality and efficiency of surgeries and to address challenges such as staff shortages. Robotic scrub nurses in particular offer great potential to address staff shortages by assuming nursing tasks such as the handover of surgical instruments. We introduce a robotic scrub nurse system designed to enhance the quality of surgeries and efficiency of surgical workflows by predicting and delivering the required surgical instruments based on real-time laparoscopic video analysis. We propose a three-stage deep learning architecture consisting of a single frame-, temporal multi frame-, and informed model to anticipate surgical instruments. The anticipation model was trained on a total of 62 laparoscopic cholecystectomies. Here, we show that our prediction system can accurately anticipate 71.54% of the surgical instruments required during laparoscopic cholecystectomies in advance, facilitating a smoother surgical workflow and reducing the need for verbal communication. As the instruments in the left working trocar are changed less frequently and according to a standardized procedure, the prediction system works particularly well for this trocar. The robotic scrub nurse thus acts as a mind reader and helps to mitigate staff shortages by taking over a great share of the workload during surgeries while additionally enabling an enhanced process standardization. Staff shortages in healthcare are an emerging problem leading to undersupply of medical experts such as scrub nurses in the operating room. The absence of these scrub nurses, who are responsible for providing surgical instruments, means that surgeries must be postponed or canceled. Robotic technologies and artificial intelligence offer great potential to address staff shortages in the operating room. We developed a robotic scrub nurse system that is able to take over the tasks of a human scrub nurse by delivering the required surgical tools. To maintain the pace of the surgery, our robotic scrub nurse system is also capable of predicting these required surgical tools in advance using artificial intelligence. The system is tested on laparoscopic cholecystectomies, a surgery, where the gallbladder is removed in a minimally invasive technique. We show that our prediction system can predict the majority of surgical instruments for this specific surgery facilitating a smoother surgical workflow and reducing the need for verbal communication. With further development, our system may help to cover the need for surgery while streamlining the surgical process through predictive support, potentially improving patient outcomes. Wagner et al. present a robotic scrub nurse (RSN) system that predicts and delivers required instruments based on real-time laparoscopic video analysis. The machine learning based system accurately anticipates the necessary tools required for laparoscopic cholecystectomies, streamlining the surgical workflow and minimizing verbal communication.