The human side of robotic surgery: Tracking surgeons’ stress in the operating room
Researchers identify various objective physiological signs of stress in surgeons during real operations
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This photograph of an operating room depicts part of the complexity that a robot-assisted procedure entails.
view moreCredit: Professor Yoshihiro Shimomura from Chiba University, Japan
Robot-assisted surgery (RAS) is one of the most advanced tools in modern medicine. These systems give surgeons extreme precision, allowing procedures to be performed through small incisions that minimize both pain and recovery time. Yet even with this sophisticated technology, operations still depend on a human surgeon, who has to stay intensely focused for hours while making medical decisions. With RAS being increasingly adopted worldwide, understanding what it demands of the surgeon is critical.
Though scientists know surgeons experience varying levels of stress during an operation, little is known about how that stress changes from moment to moment. Most research has relied on simulated surgeries or questionnaires completed after the fact, making it difficult to capture the rapid changes that occur in the operating room during a real procedure. In RAS, stress should be understood not only over time but also as a whole-body response involving the cognitive processing system, musculoskeletal system, and autonomic nervous system. Knowledge of when and how stress manifests physiologically in surgeons could help improve surgical training, how operating rooms are designed, and how well physicians are supported at work.
In a recent study published online in the journal Surgical Endoscopy on June 30, 2026, a research team led by Professor Yoshihiro Shimomura from the Design Research Institute, Chiba University, Japan, including Dr. Kaiqi Wei and Dr. Nanako Nakamura from the Graduate School of Science and Engineering, Chiba University, and Dr. Shinichi Sakamoto from the Graduate School of Medicine, Chiba University, set out to answer this question by monitoring surgeons during live operations. Their paper presents the results of an observational field study in which multiple physiological signals were recorded simultaneously from seven experienced urologists while they performed robot-assisted procedures.
Each surgeon wore lightweight sensors that recorded brain activity via electroencephalography, shoulder and neck muscle activity via surface electromyography, and heart activity via electrocardiography. Rather than interrupting surgeons’ mid-operation to ask how stressed they felt, the team used video-stimulated recall. Simply put, after surgery, each surgeon watched a recording of their own console view and marked the moments when they felt their stress level changed, rating it on a scale of 0 to 9. This enabled the researchers to match notable physiological patterns to specific moments of stress without disrupting the procedure.
By statistically analyzing 151 of these stress-rated moments across the seven surgeons, the team found that four physiological signals reliably tracked how stressed surgeons reported feeling: a pattern of brain activity linked to mental arousal increased, muscle tension in the upper shoulder increased, heart rate sped up, and the natural variability between heartbeats decreased. These signals moved together in a way that lined up consistently with how stressed surgeons said they felt, as confirmed through robust statistical analysis.
These results showcase how unobtrusive physiological monitoring can provide useful information for understanding the challenges faced by surgeons. “Combining surgeon-reported stress annotations with multimodal physiological monitoring is feasible in RAS and may provide a basis for identifying high-demand operative moments during postoperative review,” explains Prof. Shimomura.
Looking ahead, the researchers also see this approach as a way to better understand the surgical workplace itself, not just surgeons. “Beyond individual case review, surgeon-state measures could serve as an outcome for evaluating the robotic surgery work system, including console ergonomics, communication routines, workload distribution, procedure-specific difficulty, and training stage. This is the most immediate practical application of the present approach,” remarks Prof. Shimomura.
Future studies involving more hospitals and additional surgical specialties could help determine how these measurements may support human-centered surgical technology and healthier working environments for healthcare professionals. “Designing environments, equipment, and operational methods based on the results of this line of research will help manage doctors’ stress, improve surgical performance, and enhance surgeons’ own well-being. In addition, these findings could be applied to real-time stress relief interventions for surgeons, triggering briefing protocols to enhance surgical safety and supporting stress management for beginners in training using double-console systems,” concludes Prof. Shimomura.
To see more news from Chiba University, click here.
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Some of the sensors used to monitor physiological signals associated with stress are visible in this photograph. (Image excerpted from Figure 1 of the article.)
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Professor Yoshihiro Shimomura from Chiba University, Japan Source link: https://link.springer.com/article/10.1007/s00464-026-13054-3
During live surgery, physiological signals such as EEG and electromyography were recorded from the study participants while their actions were captured on video. Surgeons annotated moments when they perceived stress levels changed significantly by reviewing footage from the surgical field.
Credit
Professor Yoshihiro Shimomura from Chiba University, Japan
Reference:
DOI: 10.1007/s00464-026-13054-3
Authors: Kaiqi Wei1, Nanako Nakamura1, Megumi Shimura1, Yoshihiro Shimomura2, Xue Zhao3, Takaaki Tamura3, and Shinichi Sakamoto3
Affiliations: (1) Department of Design, Graduate School of Science and Engineering, Chiba University; (2) Design Research Institute, Chiba University; (3) Department of Urology, Graduate School of Medicine, Chiba University
About Professor Yoshihiro Shimomura from Chiba University, Japan
Dr. Yoshihiro Shimomura is a Professor at the Design Research Institute of Chiba University. His work focuses on exploring various aspects of human physiology, using methods such as electromyography and electroencephalography to delve into topics including the comfort of artificial environments, oral hygiene, stress reduction for healthcare professionals, and the definition and evaluation methods of play. He has engaged in over 130 collaborative research projects in the field of product design covering lifestyle appliances, medical devices, automobiles, and energy, as well as environmental design and lifestyle design.
Journal
Surgical Endoscopy
Method of Research
Observational study
Subject of Research
People
Article Title
Multimodal physiological correlates of surgeon stress in live robot-assisted surgery
A hands-on approach to distance medicine
Researchers develop new technology that could bring specialized medical care to rural patients.
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Dr. Pijuan Yu works on the prototype haptic display technology during a visit to Texas A&M’s School of Engineering Medicine campus in Houston.
view moreCredit: Emily Oswald/Texas A&M Engineering
Dr. Pijuan Yu sits at his lab station, focused on the task at hand. He is feeling for a lump. The glass wall to his right reveals other students and researchers as they pass, but his attention remains steady.
Two rubbery samples simulating human neck tissue lie on a smooth black tabletop. A dark cloth covers the first, preventing Yu from seeing clues in the material.
Yu takes his time considering what he feels. There’s a method to examining the phantoms, as he calls them — center, left, right, up, down, back to center. He evaluates both samples before correctly identifying which has the lump.
Simple enough.
Except Yu never touched either sample. He wasn’t even in the same room.
Yu flashes a smile down at his phone, where his labmate, postdoctoral researcher Dr. Anzu Kawazoe, is on FaceTime across the hall, physically performing the exam.
“Let’s set up another,” Yu says.
Bringing touch to telemedicine
Telemedicine commonly uses video calls to reach patients near and far, but the technology limits what senses caregivers can use during their evaluation.
Yu and his collaborators at Texas A&M University are seeking to go beyond telemedicine’s use of audio and video. They want to add an entirely new dimension: touch.
In 2023, the National Science Foundation (NSF) awarded researchers from the College of Engineering a $1.5 million grant to develop haptic technologies to advance telemedicine. Dr. Rebecca Friesen, assistant professor of mechanical engineering, leads the project to develop technology that can digitally transfer touch just as audio and video are conveyed now.
A range of consumer technologies already use haptics — think of the rumble of a video game controller, responding to an on-screen action, or the vibration of a steering wheel when a car drifts out of its lane. The word comes from the Greek haptikos (meaning “relating to the sense of touch”) and often refers to technologies that create physical sensation for users.
Friesen, who has been Yu’s Ph.D. advisor throughout his four years at Texas A&M, said that her lab is just one part of a much broader effort.
Collaborators on the project are helping the sensors collect better data, exploring how users interact with the technology, and gathering feedback from medical experts.
The ability to feel — or palpate — is an important tool caregivers use when evaluating patients. If successful, the technology researchers are developing could be used in clinical settings, allowing a nurse or technician to visit a home-bound or rural patient, perform a palpation exam, and send the video and haptic recording to a physician — located in another city, state or country — for interpretation. The haptic experience, along with a video call to the patient, would aid the physician in making their diagnosis.
The researchers envision the following: A nurse, located in a rural clinic, performs a palpation exam while wearing a sensing glove. A camera records the nurse’s hands performing the exam. With just a few seconds of delay, a physician at a medical center — like Houston Methodist Hospital — watches the video as a finger-sized haptic “display” surface simultaneously recreates the sensations captured by the glove. The physician keeps their hand still as the haptic display shifts against it, replicating the pressure applied by the nurse during the palpation. The near-real-time interaction allows the physician, nurse and patient to communicate throughout the exam, enriching the doctor’s assessment and participation.
The haptic display uses a cluster of actuators that translate the signals collected by the glove’s sensors into tactile motion. Effectively, the haptic surface is a tiny robot, shapeshifting against the user’s finger to mimic the information the sensing glove collects.
The team’s ultimate goal is to make the technology disappear from the user’s perception, tricking the physician’s senses into thinking they are interacting with a real patient. When the motion of the haptic display syncs with the exam’s video, the user is more immersed in the experience, making the hands performing the exam feel more like the user’s own.
“When we get the haptic feedback synchronized with the video, it’s really compelling,” Friesen said. “We’ve had some moments of that in controlled settings, and it’s so cool when it works. Those glimpses are very encouraging and very exciting.”
Dreaming of robots
Yu grew up in China, enthralled by the robotics in American cinema — like Transformers and Iron Man — and was determined to help make them real. He began his undergraduate studies in China and then transferred to the Florida Institute of Technology, where he graduated with a bachelor’s degree in mechanical engineering in 2020.
He continued his mechanical engineering studies as a master’s student at Northwestern University, where his work on a class research project caught the attention of Dr. Matthew Elwin, who invited Yu to work in his lab. The experience taught Yu about robotic controls — the systems that command a robot’s precise movements or tasks — and expanded his understanding of academic research. It gave him confidence in his abilities and encouraged him to apply to Ph.D. programs around the country.
When Yu received his master’s degree in December 2021, he had planned to stay on as a research engineer in Elwin’s lab as he awaited the results of his Ph.D. program applications.
However, the lab’s project was out of funding, and Elwin was unable to hire him.
Before he could resume his studies, Yu needed to find a job.
A vision of what’s possible
In January 2022, as Yu was searching for work after he graduated from Northwestern, Friesen accepted a faculty position in the J. Mike Walker ’66 Department of Mechanical Engineering at Texas A&M. Her research interests focused on human-machine interaction and the development of haptic technologies.
While developing the haptic display system over the past few years, Friesen explained that regular feedback from physicians with hands-on experience has been critical to the technology’s progress.
That feedback comes from the team’s collaborators — including physicians and students — at Texas A&M’s School of Engineering Medicine (EnMed), a four-year program resulting in a medical doctorate from the Naresh K. Vashisht College of Medicine and a Master of Engineering degree from the College of Engineering.
The team holds workshops with EnMed twice a year, either traveling to Houston or hosting the physicians in College Station, to demonstrate their progress and test the machinery. This regular feedback helps ensure that the engineering team builds a device ready for clinical use, rather than a technically impressive technology with little practical application.
Dr. Ericka Greene, an associate dean of the engineering medicine school and a physician at Houston Methodist Hospital, is one of the team’s collaborators. She said the technology could lead to portable, user-friendly healthcare devices for caregivers ranging from medical students to nurse practitioners and expert physicians.
“I’m in awe of where we’re going with this and the direction that biotechnology is taking healthcare,” Greene said. “It’s still at its basic level, but it does give us a vision of what’s possible.”
As the team refines the technology, Greene is using her years of experience evaluating patients to connect the mechanical sensations to reality. No matter how good the technology becomes, she said, teaching physicians to translate between the mechanical feedback and the sensation of a hands-on evaluation will be important to the project’s success.
“The data I get from feeling a nodule — a mass — on someone’s neck, for instance, I know what that feels like to my fingers after years of doing it,” Greene said. “I know what to expect and look for from the examination, and I don’t have to think about it. Going through this process with our co-investigators, it requires an additional cognitive step to extrapolate to a new sensation.”
Adapting the technology to the human experience is one of the project’s main goals, Yu said. The haptic applications are meant to assist people, not replace them.
Yu didn’t always view technology this way. But an unexpected opportunity opened his eyes to how engineering could change a person’s life.
From robotics to haptics
After receiving his master’s from Northwestern, Yu spent the first few months of 2022 as an engineering intern, working on control systems for autonomous vehicles at a Chicago-area startup. Then, another opportunity arose.
Elwin was collaborating with Dr. Netta Gurari of the Department of Physical Therapy and Human Movement Sciences at the Northwestern Feinberg School of Medicine to develop a device to help stroke patients. When Gurari needed to hire a research technician to join her team, Elwin recommended Yu for the role.
Although he was excited about the opportunity to join Gurari’s lab, Yu remembers being anxious about the adjustment. He was no longer focused on robotic arms and autonomous vehicles; he was dealing with humans.
“It was a whole new world for me,” Yu said. “I was asked to build a haptic device to help stroke patients, with no background in biomedical science or neuroscience.”
Fortunately, his experience in robotics translated well to his new focus on haptics.
Yu explained that actuators (responsible for creating motion) and sensors (responsible for detecting changes) are fundamental in both robotics and haptics. In robotics, mechanical sensors drive the actuators. But in haptics, the human body — including the skin and the nervous system itself — functions as both a crucial part of the sensor and the final receiver.
“Building a haptic device draws on the same engineering knowledge and the same tools as building a robotic device,” Yu said. “The real difference was the focus: everything now centered on the human, and the goal was tied to human perception rather than the machine itself.”
This distinction adds complexity to the development of haptic devices: In addition to the device’s technical function, researchers must account for the user’s experience, perception and participation. Yu needed to consider how the device’s user would interpret the mechanical feedback.
For example, is the stimulus clear to the user? Does interacting with the device cause discomfort? Do different users experience the stimulus in the same way? For Yu, learning about the technology brought humans into the mechanical world.
Working in Gurari’s lab let Yu connect his engineering work to outcomes that could affect lives. Starting in his first weeks on the project, he interacted with stroke patients who visited the lab as research participants.
“That was the first time I realized how technology can help people,” Yu said. “I met with stroke patients and talked with them — they were old and couldn’t feel anything from their hands. It made me realize how important the sense of touch is. I think that experience changed my life.”
Arriving at Texas A&M
In April 2022, just a few weeks after joining Gurari’s lab, Yu received his acceptance to the mechanical engineering doctoral program at Texas A&M.
As luck would have it, Elwin had a connection in College Station, a former Northwestern Ph.D. student who had recently joined the department: Dr. Rebecca Friesen. With Elwin and Gurari’s endorsement, Friesen welcomed Yu to her lab and became his advisor.
Yu remembers his anxiety when he arrived at Texas A&M in fall 2022. Although his time in Gurari’s lab had introduced him to haptics, that experience had been relatively short and limited.
Friesen saw it differently, though. As a new faculty member building her research lab, she needed someone experienced to begin developing new devices immediately.
She viewed Yu as a perfect fit.
“My first impression of Pijuan was that when he had a defined problem in front of him, he was going to approach it single-mindedly with 100% of his energy until it was solved,” Friesen said.
Friesen’s trust and Yu’s work ethic paid off. He accelerated development of the haptic display system in his first few months in the lab, enabling the team to collect pilot data that ultimately helped secure the $1.5 million NSF grant.
Yu said Friesen’s encouragement motivated him throughout his time at Texas A&M and gave him the confidence he needed to flourish on the project.
“Dr. Friesen’s words motivated me through my entire Ph.D.,” Yu said. “Even now, I wouldn’t call myself an expert because haptics is a huge field. But I’m confident that I know my own research direction deeply.”
Yu defended his dissertation in June and, as he graduates in August, is planning to pursue his original career path in robotics. He is returning to the field with a new perspective on human touch and the importance of reliable haptic systems — two areas he said most humanoid robot projects will need in the next phase of development.
Specifically, he wants to develop dexterous robotic hands. While current robots are adept in major movements like walking, running and dancing, Yu said the machines’ fine motor skills are lacking.
“Ask one to manipulate a tool or shuffle a deck of cards, and most of them struggle, because they rely heavily on vision rather than touch,” Yu said.
It’s a problem Yu has seen before while working in Gurari’s lab at Northwestern. Much like modern robots, the stroke patients Yu interacted with had good vision, but struggled to pick up objects because of poor communication between the sensations in their skin and their nervous system.
Yu believes humanoid robots face a related limitation.
“If they don’t have rich tactile sensing, they will never reach human-level dexterity,” Yu said.
By combining his experience with stroke patients and his expertise in haptics at Texas A&M, Yu feels equipped to address the challenge.
What the future holds
Yu sits at a conference table, facing the glass wall of his lab, a short walk from where he demonstrated the project’s progress minutes earlier. From his seat, the prototype haptic display is visible.
The project has made great strides during his four years working with Friesen and the team. But there is much left to do.
Yu’s work has shown that remote users can interpret the machine’s haptic feedback, but now he considers where the project will go next.
In preparation for his departure, Yu has spent the summer documenting the haptic display system’s functions for collaborators, including students in the Human Factors and Cognitive Systems Lab, led by Dr. Thomas Ferris, an associate professor of industrial and systems engineering. Ferris’ group is preparing to examine the human workflow of the device, seeking to improve how nurses, physicians and patients will interact with it.
But work on the system’s technical development isn’t over.
Yu’s eyes are fixed on what has been his corner of the lab, considering what new methods or technologies — maybe a new type of actuator — might need to be developed.
“It’s not easy,” Yu says, grinning.
In many ways, Yu says, the project faces technical problems similar to those it faced at the beginning. His work on the project addressed the haptic display’s recreation of motion perpendicular to a given surface — known as normal force — but future advancements will need to go further. In real-world palpations, healthcare providers also use lateral movement — shear force to an engineer. If the team hopes to accurately simulate an exam, Yu says, they will need to invent technology to record and recreate this type of motion.
“It’s a big challenge,” Yu says. “If a Ph.D. student can solve that problem, that’ll create a very big impact.”
Yu’s eyes return to the glass wall.
Wherever his path leads next, he says he’ll be following the project’s progress closely — from a distance.
By Steve Kuhlmann, College of Engineering, Texas A&M University
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Journal
Journal of Computing and Information Science in Engineering
DOI
Dr. Eugene Alford tests the haptic display technology.
Left to right: Dr. Anzu Kawazoe and Dr. Ericka Greene inspect samples simulating a human tissue.
Credit
Emily Oswald/Texas A&M Engineering
Revolutionizing Telehealth [VIDEO]
Haptic technology could transform the future of telemedicine. Researchers at Texas A&M Engineering are developing technology that allows physicians to experience the sense of touch during remote medical exams. By combining robotics, haptics and telemedicine, this research aims to improve access to specialized healthcare for rural patients.
Credit
Logan Jinks/Texas A&M Engineering
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