Shared sensory environment
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Same room, five different experiences
The thoracic operating room is one of the most sensorially demanding environments in medicine. The surgeon is reading lung tissue through a camera instead of fingertips, making force judgements from visual cues alone. The anesthesiologist is parsing a wall of alarms while managing one-lung ventilation. the scrub nurse is tracking a case that can pivot without warning, anticipating instrument needs from rhythm and sound rather than instruction. The circulating nurse is coordinating across a sterile field in a room that routinely exceeds safe noise thresholds. These are not variations on the same problem.
They are five separate sensory design failures happening in the same room, at the same time around the same patient. Let me elaborate that:
The surgeon: reading tissue through a camera
In thoracic surgery, the hands have always been the primary instrument, not the scalpel. An experienced thoracic surgeon working near the hilum is making continuous force judgements: the compliance of healthy lung parenchyma versus a tumor margin, the tension on a staple line, the resistance that tells you whether you’re in the right dissection plane or dangerously close to a vessel wall. That information doesn’t live on a screen but in the fingertips.
Minimally invasive thoracic surgery removes it. In open surgery, haptic feedback is a direct measure of interaction forced between instruments and tissue, including the resistance of the thoracic wall during instrument movement. In VATS, those signals are filtered through a port, a trocar and camera. Experience surgeons compensate by learning to read visual proxies like tissue deformation, instrument deflection, color change that substitutes for what the hands used to feel directly. Researchers would call this natural sensory substitution: the surgeon learns, subconsciously, to translate visual information into tactile judgement.
It takes years to build, degrades under fatigue and is never quite the same as original channel. The design question isn’t whether surgeons can adapt but what we are asking them to give up in order to use the tools we’ve built.
The scrub nurse: anticipation as a perceptual skill
When a thoracic scrub nurse id performing a complex resection, it is mostly prediction rather instrument management. They are reading the case and translating that into a physical arrangement of instruments before the surgeon’s hand moves. When it works, the surgeon never breaks concentration.
The tray they work from was not designed for this. It is organized around taxonomy clamps here, scissors there, staplers by type and size. That’s a catalouging logic useful for procurement, sterilization, inventory. It has nothing to do with the perceptual demands of a 6-hour lobectomy. Nobody has designed the scrub nurse’s primary interface around how a thoracic procedure actually unfolds, what gets used when, or how the arrangement of instruments on that tray either supports or undermines the anticipatory work the scrub nurse is doing every minute of the case. That is an industrial design problem that hasn’t been framed as one.
The Anesthesiologist: when auditory channel saturate
Thoracic anesthesia is among the most demanding in the specialty. One lung ventilation, collapsing one lung so the surgeon can operate in a still field requires continuous monitoring of oxygenation, pressure and hemodynamic stability across a physiology that is deliberately destabilized. All of that information arrives primarily as sound: pulse oximetry tone, ventilator alarms, pressure alerts. The anesthesiologist is, in effect, listening to a patient breathe through a wall of competing signals.
A study of 120 anesthesiologist found that alarm fatigue and information overload are the most commonly cited problems with current monitoring systems with displays described as confusing and number-coded in ways that require interpretive skill rather than intuitive reading. The monitors were designed to display data. They were not designed around the perceptual experience of the person reading them under load, in a noisy room, for hours at a stretch. Research exploring tactile display as an alternative channel for physiological monitoring reducing the burden on an already saturated auditory system has existed for decades and has not meaningfully reached commercial hardware. That gap is a design failure, not a technical one.
The circulating nurse : designing the environment for everyone else
The circulating nurse is the only person in the thoracic OR whose job is explicitly environmental. They are unscrubbed, mobile and responsible for the room supplies, documentation, sterile field coordination, communication between the team and the rest of the hospital. They manage the overall environment, track surgical supplies, anticipate team needs and act as liaison between the surgical team and other departments.
Their tools were not built for them. Documentation terminals assume a stationary, focused user. Communication systems assume a quiet room. Noise in operating rooms consistently exceeds recommended thresholds, is linked to increased cognitive load, and has been associated with complication and evidence suggests it can negatively affect communication during a crisis specifically. The circulating nurse’s primary mode of work is verbal communication across a sterile feild in exactly that environment, Every tool they use was designed for a different context, by people who are thinking of a different user.
The open question remains if it would an exercise of overdesigning.
The surgical assistant: the user nobody studied
The first assist works in the sterile field for the duration of the case holding retraction, managing suction, supporting exposure. They share the surgeon’s visual and haptic constraints but carry less procedural context and less authority to ac on what they observe. Noise-induced hearing loss is prevalent in up to 50% of OR personnel in certain surgical specialties, yet the surgical assistant, who is closest to the field and most physically exposed, has generated almost no dedicated design research.
The shared environment
A 2025 review in Langenbeck’s Archives of Surgery found that visual, auditory, olfactory, and thermal stimuli all influence team performance simultaneously, and that every team member’s senses must be active to process environmental information and respond effectively. What the that framing still misses is that the same room lands differently on 5 different people. The temperature set for a surgeon who is moving is cold for a scrub nurse standing still. The music that settle one person’s focus masks a verbal handoff for another. The alarm that is urgent for the anesthesiologist is undifferentiated noise for the circulating nurse on the other side of room.
The thoracic OR has been designed, to the extent it has been designed at all, around the person with the most institutional authority. That is not the same as designing for the team. The brief has to change from what does the surgeon need to sense, to what is every person in this room trying to read, and what are we doing about it.
Every design decision in the OR ultimately answers to the same person: the Patient. When the scrub nurse misreads the rhythm of a case, when the anesthesiologist’s attention is pulled by a false alarm, when the circulating nurse can’t be heard across the field, the patient absorbs the consequence. The tools in that room either make those 5 people better at what they are doing or they don’t. Designing for the surgeon was never enough but easiest place to start!
De Almeida, D. et al. (2025). Integrating safety culture, environment, and sensory perceptions in the operating room: a narrative review. Langenbeck's Archives of Surgery, 410.
Gillies, M. et al. (2025). Impact of environmental factors on operative team performance: systematic review. Surgical Endoscopy.
Imperatori, A. et al. (2022). The role of haptic feedback in video-assisted thoracic surgery simulation training. Shanghai Chest, 6.
Mariani, A. et al. (2023). Sensory substitution increases robotic surgical performance and sets the ground for a mediating role of the sense of embodiment: a systematic review. Heliyon, 9(11).
Ruskin, K.J. et al. (2024). Alarm fatigue and patient safety. APSF Newsletter, 39(1).
Schmid, F. et al. (2019). It's not you, it's the design — common problems with patient monitoring reported by anesthesiologists. BMC Anesthesiology, 19(98).