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CHI '26 · Honorable mention · full-paper review · confidence medium-high

The Choreography of Care: An Ethnographic Study of Human-Robot Collaboration in Makoplasty Surgeries

Jasper T Vermeulen , James L Dwyer , Alan G Burden , Glenda Amayo Caldwell , Muge Teixeira , Matthias Guertler , Ross Crawford

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This is a strong ethnographic contribution because it does not merely describe robot-assisted surgery; it redefines the unit of analysis. The paper’s main value is the careful showing of how responsibility, timing, and coordination are distributed across a surgical team rather than residing in a surgeon-robot pair.

Axes Lens

Rare contribution shape, typical evidence profile. The point here is not a score. It is to show what kind of claim the paper makes, and whether the evidence pattern is unusual or baseline in this 268 -review set.

Review Summary

This paper’s strongest contribution is conceptual rather than technical: it challenges the default HRC framing of a human and a robot as the primary interaction unit and replaces it with a richer account of surgical work as ensemble coordination. That move is persuasive because the evidence is not speculative; it comes from over 80 hours of hospital-based fieldwork, 15 observed Makoplasty surgeries, and 10 interviews. The paper’s discussion of tacit cues, negotiated boundaries, and adaptive role shifts gives concrete substance to the claim that collaboration in the operating theater is organized through a choreography of people, tools, and temporal phases. I also think the notion of temporally delegated responsibility is the most interesting empirical finding here: the surgeon remains accountable, but control is temporarily ceded to the Mako Product Specialist during technical or robotic sequences. That is a useful refinement for CHI readers because it shows that “collaboration” in safety-critical settings is not just about interface control, but about how authority and responsibility are distributed in practice. The limitations are appropriately stated and matter for interpretation: this is a single-hospital study with a specific staffing model, spatial layout, case mix, and adoption history, so the findings should be read as a situated account rather than a universal model. Even so, the paper has clear field value because it offers a vocabulary and analytic lens that can travel to other co-located surgical HRC settings. The design implications are plausible, but they should be understood as grounded recommendations emerging from one setting, not as validated prescriptions across all robotic surgery contexts.

What Changed

Canon before

Prior CHI and HCI accounts of human-robot collaboration often center a dyadic model: one human operator and one robot, with interaction framed as direct control, teleoperation, or tightly bounded collaboration.

Departure from common sense

The paper argues against the intuitive dyad model of surgical HRC and instead treats the operating theater as a multi-actor choreography. That reframing is non-obvious because it shifts attention from the robot and surgeon alone to tacit cues, negotiated boundaries, and supporting staff who actively sustain coordination.

Actual novelty

The paper’s novelty is an ethnographic account of temporally delegated responsibility in Makoplasty: the surgeon keeps ultimate accountability while control shifts to the Mako Product Specialist during technical or robotic sequences. It also shows phase- and space-dependent role redistribution across the operation, extending HRC analysis beyond a simple dyad.

Evidence

The evidence supports a qualitative, field-based contribution grounded in over 80 hours of hospital fieldwork, 15 observed Makoplasty surgeries, and 10 interviews. The paper’s claims are backed by explicit discussion of delegated responsibility, multi-actor coordination, and a single-site limitation that constrains transferability.

Limits

Method limits

The study is qualitative and ethnographic, so it offers interpretive depth rather than causal identification or broad statistical generalization. Its claims depend on situated observation, vignettes, and interviews rather than experimental comparison.

Deployment limits

The findings are tied to Makoplasty surgeries in one teaching hospital and to the specific socio-technical arrangement of that setting. Design implications are therefore most directly relevant to co-located surgical HRC systems with distributed roles, not all robot-assisted procedures.

Boundary conditions

The account is situated within a single hospital with a specific staffing model, case mix, spatial layout, and adoption history. The paper also notes that the observed teaching hospital typically has smaller rooms than other hospitals in the country, which may shape coordination patterns.

Manual check: No manual check required for schema completeness; the main caution is interpretive scope because the evidence is single-site and qualitative.

Position in field

This paper pushes surgical HRC away from a dyadic interaction model and toward an ensemble or choreography perspective. In CHI terms, it contributes a practice-level empirical reframing that is especially relevant for co-located, safety-critical collaborative systems.

Abstract

Human-Robot Collaboration (HRC) in surgery is rarely a straightforward interaction between one human and one robot. In joint replacement surgeries performed with the Mako robot (Makoplasty), the robotic arm enhances surgical precision while also affecting how collaboration unfolds in the operating theater. Utilizing over 80 hours of hospital-based fieldwork, including observations of 15 Makoplasty surgeries and 10 interviews, we examine how the Mako robot shapes surgical HRC. We demonstrate how surgical teams coordinate via tacit cues, negotiated boundaries, and adaptive role shifts across phases of operation. Through vignettes, we highlight the pivotal role of supporting actors, such as nurses and robotic specialists, in maintaining flow and reveal how responsibility is distributed temporally among actors depending on task demands. We argue that surgical HRC is best understood as a multi-actor choreography rather than a surgeon-robot dyad, offering design implications for co-located surgical HRC systems that support distributed collaboration.