Beyond Boundaries

Beyond Boundaries: A Phenomenological Exploration of Teleoperative Surgical Systems and the Exteriorisation of the Surgical Gesture

My essay for TETI Journal is a phenomenological inquiry into the exteriorisation of the surgical gesture in teleoperative systems: what happens to the gesture once it leaves the hand, and how proximity and distance arise from it in equal measure.

The text opens on a scene: for more than thirty minutes the surgeon has been stuck headfirst with both hands inside the patient’s abdomen, and from inside precise instructions leak out. No one is in fact inside the body; in an operating room equipped in this way, however, the word “really” becomes increasingly ambiguous.

The exteriorisation of the gesture is not new: André Leroi-Gourhan describes it in the blade production of the Upper Palaeolithic, where the tool leaves the hand only to return, after further working, as a set of new tools. It recurs in the waldos with which the Los Alamos laboratories of the 1960s handled radioactive material behind a concrete wall, and in the SRI and DARPA prototypes of the 1980s and 1990s. In the excavators of the Carrara marble quarries, a foreman frees gigantic slabs of marble from the rock face with the tiniest of hand signals. In every case the hand itself no longer touches the material; the interaction passes to the last link in a chain of transformation and translation steps, which robotics aptly calls the end effector.

The Da Vinci® surgical system by Intuitive Surgical, which emerged from these prototypes, carries the displacement further by replacing mechanical force transmission with digital signal transmission. The design of the console dictates the surgeon’s posture: it forces them into a seated position with the head tilted slightly downward, so that their gaze would fall on their own hands if the display did not obscure it. This creates the proprioceptive illusion of looking at one’s own hands while actually looking at a screen. The system thus produces a unique ambivalence of cognitive hyperproximity and spatial distance: from the surgeon’s perspective, the intervention no longer takes place on the patient but inside them.

Working with the robot is therefore a calculated game with the derealisation of the environment and the reassurance of reality — derealisation in the moment of immersion, reassurance in the moment of re-emergence. That remote surgery is practically never performed with these systems, although they were developed for it, presumably has less to do with latency or legal position than with this cognitive and spatial perception of the surgeon.

The scene rests on my participant observation in the research project Robotic Operations; the overlay of hand and instrument movements that the essay describes goes back to my bachelor’s thesis Screen Spaces. The essay brings both together with the theme of the issue: transindustriality as the ongoing circulation between industrial, technological, and cultural mutations.

Published in November 2024 in the first issue of TETI Journal, On Transindustriality, edited by Anne-Laure Franchette, Gabriel N. Gee, Stephanie Gygax, and Caroline Wiedmer for TETI Press.