Etude de l’impact des nouvelles technologies sur les stratégies opératoires des chirurgiens par l’analyse des communications sur le terrain

This study aimed to analyse the impact of the introduction of new technologies in the complex and dynamic field of surgery according to the expertise. The medical sector is one of the most investigated in ergonomics and work psychology studies. Although the study of this phenomenon is not new, our purpose is relevant because of the rapid introduction of new technology in surgery (with very few studies on its organisational impact), its implication for surgeon’s training and the risks for the patient. Furthermore, our conclusions might be extended to other complex work situations.
Surgery has considerably evolved and a lot of interventions are now performed by laparoscopy: in this procedure, a camera and the instruments are introduced into very small incisions in the skin and surgeons guide their movements by watching a 2D screen. This technique involves some disadvantages (principally, a 2D view and instruments with low dexterity) that are now removed by a new robotic system (Da Vinci Robotic System). Nevertheless, if this new system offers some essential advantages, it provokes many changes and new constraints in the way to operate and in the role and status of all actors: with this system, the surgeon is isolated and operates with a 3D view and high dexterity instruments while the rest of the team has to manage with a 2D view and instruments with very low dexterity. By all these aspects, the new system may generate different situational references for each actor and might be at the origin of new human errors.
In this context, we evaluated the adaptation processes and the changes produced by this system using the communication analysis. In a first field study, we evaluated the impact of its introduction on short-term adaptation processes by a comparison of the communications in classical laparoscopy with the communications with the robotic system. In a second study, we analysed the difference between novices and experts using this system in order to emphasize the long-term adaptation evolution and the steps in the training with this system.
Our results showed that the robotic system was more complex and necessitates a long adaptation time when subjects were novices. This complexity led to an increase in the communications between the team members in order to construct common action references despite of diverse quality images. Our data from the second study showed that all categories of communication do not have the same role in the adaptation process and that their occurrence varied according to the expertise level. Indeed, the novice-expert comparison allowed us to emphasize which communications were necessary in the learning phase and which communications were permanent and thus useful for experts too. We showed that the communications might be distinguished in two main types: (1) some were necessary for the learning and disappeared with expertise, these communications concerned the spatial orientation and manipulation categories, (2) while communications about order and confirmation did not decrease and seemed to be indispensable for an accurate cooperative work and common situation awareness. These communications show an accommodation process that transforms the activity by a work division. This last finding is relevant because robotic surgery is similar to the remote control situations in which communications constitute the only way to construct and keep a same situational reference for all involved actors.