Surgical wayfinding and navigation processes in the human body

Abstract

During minimally invasive therapies (MITs), surgeons and interventionists rely on medical images as cartographic overviews over the working and navigation area in the patient’s body. MITs are reported as highly demanding for the surgeon’s fine motor skills as well as for his cognitive capacities (Berguer 1999). Buess (2008) reports that many surgeons only master know-how for simple MITs and points out that different skill are needed for MITs than for open surgical procedures. MITs are characterized by limited access to the working area and thus also by limited and indirect spatial information. Cognitive load of the surgeon arises from the need not only to maintain spatial awareness but also to make correct decisions and solve problems. Cao and Milgram (2000) could show that the abdominal surgeons use considerable cognitive spatial capacities to maintain spatial awareness in the inner space of the anatomical cavity while operating in the colon with the help of an endoscopic video (colonoscopy). Dominguez (2001) could show differences in decision making and problem solving of experienced surgeons and surgeons in training and highlights their importance for surgical competency and excellence. In order to reduce surgeons and interventionists cognitive workload during MITs, considerable amount of effort is actually undertaken in the development of surgical information and navigation systems. In order to design intuitive tools that support medical experts in their time critical wayfinding and navigation tasks (in a working environment with high risks), a deeper understanding of safe and effective navigation and wayfinding strategies is mandatory. The development process of surgical information and navigation systems and their user interfaces could be substantially supported with a plain model that makes the complex information need–spatial–orientational as well as safety-strategical—comprehensible for designers and engineers. In earlier work (within ARISER network), a plain model has been introduced based on the observed similarities in navigation strategies of surgeons (Studeli et al. 2007) and classical maritime navigators (Bowditch 1995, p. 371ff). Both experts rely on prudent navigation strategies which are described in the model as iterative and multifactor problem solving and quality control cycles (Studeli 2008, 2009). This model has been evaluated positively by four surgeons from different fields (abdominal, cardiac and pelvic surgery). One of the remaining questions was how to incorporate the prominent role of spatial mental models in surgery (e.g. Cao and Milgram 2000). The here presented research describes the analysis of ethnographic data to link the ‘‘iterative and multifactor problem solving and quality control cycles’’ with the five elements of mental models of Lynch (1960). T. Studeli (&) Faculty of Industrial Design Engineering, Delft University of Technology, Landbergstraat 15, 2628 CE Delft, The Netherlands e-mail: t.p.studeli@tudelft.nl