Disclaimer: This site does not provide medical advice. The user interfaces and terminology presented on this page are for non-medical informational purposes only. They are solely intended to convey my work process and output. The content shown here may not match what has been implemented on the da Vinci Surgical System and it should not be used for any training purposes.
The da Vinci Xi Surgical System is a robotic surgical system designed to facilitate minimally invasive surgery. It is commonly used for prostatectomies, hysterectomies, and a myriad of other urologic, gynecologic and general surgical procedures. The system consists of a surgeon's console, a vision cart, and a patient-side cart with four interactive robotic arms. The surgeon uses the console's controls to precisely maneuver a stereoscopic camera and instruments, which are installed on the robotic arms.
Electrosurgery uses electrical current moving through a metal instrument to cut through (also coagulate, desiccate, or fulgurate) biological tissue. One of the major benefits of using it is doctors can make precise cuts to tissue (e.g. to remove a tumor) while minimizing blood loss. Given the importance of this technology, an integrated electrosurgical generator for powering energy instruments is included with every da Vinci Xi and X vision cart.
As part of one of the da Vinci system’s software updates, we introduced an important electrosurgical control, power limits, to help surgeons reduce the amount of smoke and char in our system’s operating field. Power limits can accomplish this by putting a user-adjustable “ceiling” over power fluctuations. Their introduction had significant implications for the UI because users needed new information and controls to iteratively fine tune the setting. Power limits also added another level of complexity to applying electrosurgical settings, which were already cumbersome to manage before the software update. I led the UX design effort to address these challenges.
The power limit controls we were introducing were going to be unfamiliar to many surgeons. It was therefore important that the UI support experimentation with settings, so doctors could discover what works best for them. For a given electrosurgical mode, effect and power limit settings typically need to be fine tuned in tandem to get a desired result. So I designed a UI that included all the associated controls in one place. That way, multiple settings could be tweaked back-to-back without being slowed down by the closing and opening of windows in the UI. Iterative adjustments could be made rapidly by the operating room staff at the surgeon’s behest while the surgeon evaluated how the settings affect tissue.
Also included in this UI is a real-time visualization of power output (see video below), including peak and average power output readings, to help surgeons understand the relation between power output and negative side effects, like smoke and char.
Given this UI’s potential to positively impact clinical outcomes, I tested it extensively to get it to a level a usability I was happy with. I created static mockups and interactive prototypes that went as far as simulating fluctuating power output to evaluate with users. We brought the prototype to hospitals to get feedback from operating room staff, brought doctors to our office to test it and held numerous design reviews with internal stakeholders.
If surgeons want to adjust electrosurgical settings independently, they can do so on their console’s touchscreen instead of being dependent on surgical staff making adjustments on the generator, which is almost always out of the doctor’s reach. The challenge I had was with this screen’s size, as it’s only 5 x 3.75 inches. There are a lot of UI elements that needed to fit in a small space, so I had to prioritize what was at the forefront and what could be accessed after a tap.
Power limit controls and presets were two feature sets that did not need to show at all times on the electrosurgical control panel. The solution was to have the power limit sliders replace the presets when the user wanted to access them. The UI elements were designed in my interactive prototype to smoothly animate into their new positions so users would be less disoriented with the new arrangement.
Applying electrosurgical settings is an important process that if done incorrectly could pose a safety risk. For example, if a doctor expects a low power setting when it is actually set high, patient tissue could end up unintentionally damaged.
Before the software update, these settings, of which there are several, could only be applied manually one at a time. Sometimes this was done by surgical staff referencing one of multiple sets of doctor’s preferred settings taped on pieces of paper to the vision cart. One can imagine how errors could occur here. With the introduction of power limits, which resulted in the creation of several more settings, it became even more important to develop a way for surgeon’s preferred electrosurgical settings to be applied safely all at once.
Customizable electrosurgical presets were designed to address this issue. Each surgeon would be allowed to have up to three associated with their account on the surgeon’s console. Similar to how someone might have radio station presets in their car so they can save one once they hear something they like, surgeons have electrosurgical presets to capture their settings once they are pleased with them. They may even choose one of their presets to apply by default at login so they can easily get the settings they want after signing in at the surgeon’s console.