L’objectif de cet article est d’étudier les impacts des changements ainsi que les processus d’adaptation lors de l’introduction d’une nouvelle technologie en chirurgie, par l’analyse des communications recueillies en situation réelle. Pour cela, nous avons comparé les communications recueillies lors de l’utilisation de deux techniques différentes (laparoscopie classique et système robotique, étude 1) ainsi que les communications échangées lorsque les équipes sont composées de chirurgiens experts ou novices avec la nouvelle technologie (étude 2). Nos résultats montrent non seulement que le temps opératoire augmente et que le nombre de communications est plus élevé lors de l’introduction de la nouvelle technologie, mais nous mettons également en évidence l’existence de deux types de communications qui se distinguent selon l’expertise des acteurs : d’un côté, les communications qui traitent de la manipulation et de l’orientation spatiale, qui disparaissent avec l’expertise et qui mettent en évidence une stratégie d’adaptation à court terme et de l’autre, les ordres et les confirmations qui restent présents dans la pratique experte et qui témoignent d’un changement radical de structure de la tâche, induisant un mode de contrôle symbolique basé sur l’adressage verbal et augmentant le coût cognitif dans les situations de téléopération.
This study aimed to analyse the impact of the introduction of new technologies into the complex and dynamic field of surgery, according to the expertise involved. The medical sector is one of the most investigated in ergonomics and work psychology studies. Indeed, the study of this phenomenon is not new. However, our research remains relevant because of the rapid introduction of new technology in surgery (together with a lack of studies on its organisational impact), and the implication of new technology for the training of surgeons and risks for patients. Furthermore, our conclusions might be extended to other complex work situations.Surgery has evolved considerably. As a consequence, many interventions are now performed by laparoscopy. In this procedure, a camera and surgical instruments are introduced into very small incisions in the skin and surgeons guide their movements by watching a 2D screen. Such a technique has disadvantages (principally, the view is 2D and instruments have low dexterity). The introduction of a new robotic system (Da Vinci Robotic System) eliminates these disadvantages and offers some essential advantages. However, it also gives rise to many changes and new constraints in the way that surgeons operate, as well as changes to the role and status of all actors. With this system, the surgeon is isolated and operates with a 3D view and high dexterity instruments, while the rest of the team has to manage with a 2D view and instruments with very low dexterity. With regard to these aspects, the new system may generate different situational references for each actor and might be at the origin of new human errors.In this context, we evaluated the adaptation processes and the changes produced by this system using communication analysis. In an initial field study, we evaluated the impact of its introduction on short-term adaptation processes through a comparison of the communications made during a classical laparoscopy and those made when using the robotic system. In a second study, we analysed the difference between novices and experts using this system in order to emphasize the long-term adaptation evolution and the steps taken in training to use this system.Our results showed that the robotic system was more complex and necessitated a long adaptation time when subjects were novices. This complexity led to an increase in the communications made between the team members in order to construct common action references, despite diverse quality images. Our data from the second study showed that all categories of communication do not have the same role in the adaptation process and that their occurrence varied according to the level of expertise. Indeed, the novice-expert comparison allowed us to emphasize which communications were necessary in the learning phase and which communications were permanent and thus useful for experts too. We showed that the communications might be categorized into two main types: (1) communications necessary for learning, which disappeared with expertise; these communications relate to spatial orientation and manipulation, (2) communications relating to order and confirmation, which did not decrease and seemed to be indispensable for accurate cooperative work and common situation awareness. These communications show an accommodation process that transforms the activity through work division. This last finding is relevant because robotic surgery is similar to remote control situations in which communications constitute the only way to construct a situational reference that is the same for all involved actors.
