The Choreography of Care: An Ethnographic Study of Human-Robot Collaboration in Makoplasty Surgeries

Paper Title

The Choreography of Care: An Ethnographic Study of Human-Robot Collaboration in Makoplasty Surgeries

Publication Info

• Topic area: Human-Robot Collaboration (HRC) in co-located surgical environments.
• Keywords: Human-Robot Collaboration, Makoplasty, surgical robotics, ensemble teamwork, co-located HRC, Mako robot, ethnography, distributed cognition, surgical workflow, robotic-assisted surgery.

Background and Problem

• Problem / challenge: Existing research on surgical robotics predominantly focuses on teleoperated systems, such as the da Vinci robot, which separates the surgeon from the team. This overlooks the unique dynamics of co-located systems like the Mako robot, where human and robotic actors share physical space, requiring close coordination and negotiation of roles.
• Significance: Understanding co-located HRC is critical for designing robotic systems that support distributed teamwork in high-stakes environments like operating theaters, where precision, coordination, and safety are paramount.
• Motivation and related work: Prior studies have examined teleoperated robotic systems and non-robotic co-located systems, but little attention has been given to how co-located robotic systems reconfigure teamwork, responsibility, and spatial negotiation. This study addresses this gap by focusing on the Mako system in Makoplasty surgeries.

Solution

• Proposed approach: Ethnographic study of Makoplasty surgeries to analyze how human-robot collaboration is enacted as an ensemble practice in co-located operating theaters.
• Novelty:
  1. Empirical contribution: Detailed ethnographic account of Makoplasty, highlighting the co-located ensemble of surgeons, Mako Product Specialists (MPS), and scrub nurses.
  2. Conceptual contribution: Framework of delegated responsibility and spatial negotiation in co-located HRC.
  3. Design contribution: Guidelines for ensemble-centric design of surgical robotic systems.
• Procedure and key techniques:
  • Conducted 80+ hours of fieldwork, including observations of 15 Makoplasty surgeries and 10 informal interviews with surgical staff.
  • Used socio-technical grounded theory (STGT) to analyze interactions and develop ethnographic vignettes illustrating key moments of collaboration.
  • Focused on pre-operative, intra-operative, and post-operative phases to capture the dynamics of teamwork and role negotiation.

Results

• Concrete findings:
  • Delegated responsibility is dynamically redistributed across phases, spatial constraints, and team experience.
  • Trust, tacit signaling, and anticipatory practices enable efficient coordination and tempo maintenance.
  • The MPS plays a critical role in bridging technical and clinical domains, supporting the surgeon and scrub nurse.
  • Early missteps (e.g., registration failures) create cognitive disruptions that require deliberate tempo repair to re-synchronize the team.
• Advantage over baselines:
  • Demonstrates how co-located HRC differs from teleoperated models by emphasizing ensemble coordination rather than dyadic surgeon-robot interactions.
  • Highlights the importance of designing for the entire surgical team, not just the surgeon-robot dyad.
• Experiments / evaluation:
  • Observed 15 procedures (7 Total Knee Arthroplasty, 6 Total Hip Arthroplasty, 2 Partial Knee Arthroplasty) at a teaching hospital.
  • Informal interviews with 10 staff members (3 surgeons, 4 MPSs, 3 scrub nurses) provided insights into teamwork and robotic system use.
  • Data analyzed through vignettes capturing spatial, temporal, and role-based dynamics of HRC.
• Limitations and future work:
  • Study limited to a single hospital with specific room layouts and staffing models.
  • Future research should explore other hospitals, robotic platforms, and less standardized surgical contexts.
  • Mixed-methods approaches and prototyping ensemble-ready features are recommended for further validation.

Summary

This paper reframes surgical Human-Robot Collaboration (HRC) as an ensemble practice, emphasizing the dynamic redistribution of responsibility and coordination among surgeons, Mako Product Specialists (MPS), and scrub nurses in co-located operating theaters. Through ethnographic observations and vignettes, the study highlights how trust, tacit signaling, and adaptive role shifts maintain surgical rhythm and precision. The findings challenge dyadic models of HRC and propose ensemble-centric design principles to support distributed teamwork. These insights are applicable to designing robotic systems that enhance collaboration, efficiency, and safety in high-stakes environments.