title: A cyber-physical management system for delivering and monitoring surgical instruments in the OR.
abstract: BACKGROUND
  The standard practice in the operating room (OR) is having a surgical technician deliver surgical instruments to the surgeon quickly and inexpensively, as required. This human "in the loop" system may result in mistakes (eg, missing information, ambiguity of instructions, and delays).
  
  
  OBJECTIVE
  Errors can be reduced or eliminated by integrating information technology (IT) and cybernetics into the OR. Gesture and voice automatic acquisition, processing, and interpretation allow interaction with these new systems without disturbing the normal flow of surgery.
  
  
  METHODS
  This article describes the development of a cyber-physical management system (CPS), including a robotic scrub nurse, to support surgeons by passing surgical instruments during surgery as required and recording counts of surgical instruments into a personal health record (PHR). The robot used responds to hand signals and voice messages detected through sophisticated computer vision and data mining techniques.
  
  
  RESULTS
  The CPS was tested during a mock surgery in the OR. The in situ experiment showed that the robot recognized hand gestures reliably (with an accuracy of 97%), it can retrieve instruments as close as 25 mm, and the total delivery time was less than 3 s on average.
  
  
  CONCLUSIONS
  This online health tool allows the exchange of clinical and surgical information to electronic medical record-based and PHR-based applications among different hospitals, regardless of the style viewer. The CPS has the potential to be adopted in the OR to handle surgical instruments and track them in a safe and accurate manner, releasing the human scrub tech from these tasks.
authors.affiliation: Purdue University, West Lafayette, IN, USA.
authors.forename: Yu-Ting
authors.initials: YT
authors.lastname: Li
authors.forename: Mithun
authors.initials: M
authors.lastname: Jacob
authors.forename: George
authors.initials: G
authors.lastname: Akingba
authors.forename: Juan P
authors.initials: JP
authors.lastname: Wachs
mesh_terms: D003491:Cybernetics / Q000295:instrumentation* / Q000379:methods; D004867:Equipment Design; D005868:Gestures; D006801:Humans; D009872:Operating Room Technicians; D009873:Operating Rooms; D010363:Pattern Recognition, Automated; D012371:Robotics / Q000295:instrumentation*; D012984:Software; D025321:Surgery, Computer-Assisted / Q000295:instrumentation* / Q000379:methods; D013525:Surgical Instruments