Building a Better Robotic Operating Room: Researchers Say Design, Communication Issues Could Impact Outcomes

BUFFALO, N.Y. — As robot-assisted surgery changes the traditional interrelationships of surgical teams with the technology around them in the operating room, new opportunities arise for understanding and optimizing operating-room processes. In a series of three studies, researchers from Roswell Park Comprehensive Cancer Center and the University at Buffalo (UB) have examined the dynamics of the robot-equipped operating room, sharing findings they hope can be used to streamline workflows and improve patient care.

The studies are a collaborative effort of the Applied Technology Laboratory for Advanced Surgery (ATLAS) program at Roswell Park and human factors faculty and students in the Department of Industrial and Systems Engineering within the UB School of Engineering and Applied Sciences.

The latest paper in the series, published online and in print by the Journal of Surgical Education, documents the team’s efforts to design an approach for accurately capturing team communications and activities during robot-assisted surgery. The researchers recorded and analyzed 37 different robot-assisted surgeries performed in an operating room equipped with cameras and microphones, focusing on the nontechnical aspects of the procedures such as communications, ambulatory movements and procedural interruptions. They report that this approach allowed them to effectively monitor and assess the surgical team activities, including movements and interruptions that were determined to be avoidable.

“By identifying and analyzing team communications, procedural interruptions and ambulatory movements within the robot-assisted surgical arena, we can craft evidence-based strategies for improving operating-room layouts, improve the efficiency, safety and efficacy of robot-assisted surgery,” says Khurshid Guru, MD, Director of Robotic Surgery and Professor of Oncology at Roswell Park, who was lead author on the three papers.

“We were able to capture data and characterize pathways in the high-stress environment of the operating room with a goal to minimize surgical errors and loss of valuable operative time,” says Lora Cavuoto, PhD, Assistant Professor of Industrial and Systems Engineering at UB.

This latest work followed related studies published online ahead of print earlier this year by the journals Urology and BJU International, both of which were based on retrospective analysis of 10 robot-assisted radical prostatectomies. In those studies, respectively, the authors report that:

  • 14% of procedural interruptions — which accounted for 9% of total operative time — were potentially avoidable, and these preventable interruptions were less frequent in surgeries where the team included members who had worked with one another previously
  • More than half of the movements during RAS can be eliminated with an improved operating room setting; congestion of the space around the surgical team can lead to workflow challenges

“It’s our hope that these striking findings will guide the training of surgical teams and inform the future design of robot-equipped operating rooms,” adds Dr. Guru.

Co-authors include Ann Bisantz, PhD, Chair of Industrial and Systems Engineering at the University at Buffalo.

All three papers are available online: “The Loud Surgeon Behind the Console: Understanding Team Activities During Robot-Assisted Surgery” is available at; “Evaluation and Impact of Workflow Interruptions During Robot-assisted Surgery” at; and “Ambulatory movements, team dynamics and interactions during robot-assisted surgery” at

The work was supported by a grant from the Roswell Park Alliance Foundation.


About Roswell Park:
The mission of Roswell Park Comprehensive Cancer Center is to understand, prevent and cure cancer. Founded in 1898, Roswell Park is one of the first cancer centers in the country to be named a National Cancer Institute-designated comprehensive cancer center and remains the only facility with this designation in Upstate New York. The Institute is a member of the prestigious National Comprehensive Cancer Network, an alliance of the nation’s leading cancer centers; maintains affiliate sites; and is a partner in national and international collaborative programs. For more information, visit, call 1-800-ROSWELL (1-800-767-9355) or email Follow Roswell Park on Facebook and Twitter.

About the University at Buffalo:
The University at Buffalo is a premier research-intensive public university, the largest and most comprehensive campus in the State University of New York. UB's nearly 30,000 students pursue their academic interests through more than 300 undergraduate, graduate and professional degree programs. Founded in 1846, the University at Buffalo is a member of the Association of American Universities.

Media Contact

Deborah Pettibone, Roswell Park Cancer Institute