Surgical Design for Surgical Equipment

Posted inThe Daily Heller
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Intuitive Surgical designs and manufactures a robotic surgical system called da Vinci. Mike Hanuschik, who leads a design and product management team, said something that recently piqued my interest: “Intuitive Surgical works at the nexus of design, graphic design, and engineering.”

With elderly care and the younger public’s need for medical services on a steady upswing, the health-care industry has, in fact, been a boon for product, graphic, and “service” designers. Da Vinci uses tiny wristed instruments and magnified 3-D vision to enable surgeons to feel like they are working with their own hands inside of a patient. It has also developed enhanced capabilities for the surgeon, like tissue fluorescence, which helps them quickly identify key anatomical structures by making them glow.

Surprisingly, Hanuschik, 35, stumbled into his position without any formal design education. Eleven years ago he attended a job fair after getting out of the Navy, where he repaired displays and interfaces for fighter jets. He was offered a choice of jobs: work on batteries or work on da Vinci. “I chose da Vinci,“ he says. He took a job at Intuitive first as a product support engineer. He later moved into a product management role, and now he leads a design and product management team for the da Vinci system.

Hanuschik’s enthusiasm is contagious. And since I am a member in good standing of the aging-baby-boomer generation—who are likely to face major and minor invasive surgery—I was interested in learning much more about how Intuitive Surgical is indeed “revolutionizing” the field and is “the nexus” of design and engineering. The following is a lightly edited version of an e-mail exchange that began in early November.

What exactly is your job at Intuitive Surgical?

My job is to make sure we are developing products with the right features; that we are designing with high standards of craftsmanship; and, most importantly, that we are hiring the very best design talent. I also take pride in ensuring that the emotional aspects of the system (the graphics, the forms, and the ease of use) accurately reflect the incredible level of engineering it takes to make this system work.

You’ve said that Intuitive Surgical “works at the nexus of design, graphic design, and engineering.” How?

Our system involves the convergence of 3-D vision, fully-articulating instruments, haptic feedback, touch, and touchless interfaces. The graphic-, interaction-, and industrial-design teams work with these technologies to make sure the system is useful, usable, and beautiful. Of course, none of this can become real without the engineering team that also participates heavily in the designs. We even have some very gifted engineers on our design team, so there is a large amount of overlap. It is sometimes hard to tell who the designer is and who the engineer is, because of the high level of collaboration between the two groups.

When developing surgical equipment, what must a designer have uppermost on his mind?

Patient safety and efficacy of the system are always foremost in the minds of the designers and engineers. In many ways, graphic design for surgical equipment is not too different from designing for something like a smartphone app. There is a goal that needs to be met for the user, and the designer is in charge of making sure that goal is efficiently achieved. All of the same methodologies apply.

Have you seen your machines in operation?

I’ll never forget the first time I observed a pediatric case. I watched as an impossibly cute four-year-old girl walked down the hall and into the OR to have a procedure performed with our system. It really brought home the gravity of the work we are doing. The fantastic thing that happens as a result of this high-stakes environment is that we end up attracting the types of people who love deep challenges, who must work on the frontiers of technology, who seek out chaos and impossible problems so they can wrestle them to the ground. Whenever we get together for an all-hands meeting, it’s almost like being at a TED conference with the number of smart and creative people we have who desire to make a positive impact on society.

Is there an acceptable visual language? Is there room to push boundaries?

We certainly try to make sure the look of the product is appropriate for the environment. We do get quite a bit of freedom within those constraints to push boundaries. For instance, we used more traditional 2-D graphics in our 3-D environment for our latest platform, the da Vinci Si. For future generations, we are experimenting with 3-D graphics. To do this we’ve enlisted the help of visual effects designer Jayse Hansen, who did many of the inspired interfaces for movies like Iron Man, The Avengers, and several other big blockbusters. While the visual language used in the movies is too complex for the austerity of the OR, a 3-D “holographic” interface is actually quite appropriate; not because it is beautiful and really cool, but because there is a real functional benefit in being able to interact with 3-D objects in the 3-D space we provide for the surgeon. I honestly don’t know of any other company that is getting to explore this unique design frontier.

Surgery is an invasive procedure, which entails risk. What is the objective of your surgical machines? Is it to reduce danger, increase the odds of success, or something that the average patient is not conscious of?

We want to make the benefits of minimally invasive surgery available to as many patients as possible. These benefits include significantly less pain, a shorter hospital stay, and a faster return to normal daily activities, as well as the potential for better clinical outcomes. Safety is always of primary concern because of the nature of our work. Beyond that, we want to enable OR teams with enhanced clinical capabilities that are easy to use so they can focus on performing the best possible procedure instead of being distracted or confused by the technology.

How has the design of surgical equipment changed in the past 10 years?

A lot of new technology has been incorporated into medical devices, but I don’t think this has been done very well in most instances. As an example, we recently compared the average setup times of two different generations of a cautery device we use with our system. The old device had a few buttons on it and limited functionality, while the new device had incorporated a fancy new touchscreen and lots of questionable features. The new device more than doubled the setup time of the old device. Some might reasonably say the culprit was a poorly designed
interface—but when you look deeper, you see the consequences of devices designed purely for business desires. Instead of trying to solve real problems, they decided to see how they could increase the perceived value of the product and charge more money. This kind of “innovation” is fairly common in the medical-device market, but it leaves the door open for smart, nimble competitors to come and disrupt these stagnated companies.

Is this true across the board?

To be fair, there are some excellent examples of good design in medical devices. The folks over at Ethicon Endo-Surgery recently released a harmonic generator that is just fantastic. It’s always satisfying to work with products designed by people who craft with a high level of depth and understanding.

You said that one aspect of your job is to ensure that “the emotional aspects of the system . . . accurately reflect the incredible level of engineering it takes to make this system work.” How essential is this?

Great question, and one I think about quite a bit. Emotional design matters a great deal in the work we do. Humans are emotional creatures that are inspired by beauty, that trust objects of high quality, that feel empowered when things seem simple. When done well, emotional design is the cornerstone of the brand image, which is the feelings and thoughts produced by a user’s experience with a company’s products and services. So many companies fail to understand this dynamic, thinking aesthetics is only about beauty. Emotional design is really about skillfully inspiring feelings and thoughts.

And what virtue is this “emotional design”?

One might argue that emotional design will set Intuitive apart because it shows we care deeply about how we make people feel and it reflects the reverence we have for what is happening in the operating room. The other aspect of emotional design for us internally is the realization that what we are doing from a design and engineering standpoint will ultimately have an impact on someone’s life. Lastly, I have an ulterior motive in that know it will attract the best talent, and there is nothing better than working with passionate, inspired people. Creating a culture of inspiration is critical if we are going to attract and retain world-class individuals. There’s a great quote from Antoine de Saint-Exupéry that captures this idea: “If you want to build a ship, don’t drum up people together to collect wood and don’t assign them tasks and work, but rather teach them to long for the endless immensity of the sea.”

How does graphic design function in your world?

We want to create a beautiful, imaginative, informative, and calm environment that conveys respect for the work being done by the surgical team. It’s funny—in many ways, the graphic design is the least technical part of the system, but it is how the user comes to appreciate the intense complexity and precision of the system. We are bridging the image and the reality of the things we are working on.

I look at most medical graphic identities, and every so often they transcend cliché. What should a logo in this genre do, and how should it function?

You’re being generous when you say “every so often.” Concerning logo design for medical devices, the Paul Rand school of thought still applies. A well-designed logo is mostly a simple, tasteful triggering mechanism for the brand image, as opposed to a holistic representation of the company’s values. A logo gets its value from the product it represents and, ideally, it should appeal to both designers and businessmen.

Is good design appreciated by your clients?

The design group at Intuitive has several clients. Obviously, there are the users of the system, the people that purchase the system, our executive staff, and the various product stakeholders in the company. But perhaps most strategically, our clients are our partners in engineering. I’ve talked a lot about emotional design, and sometimes that conversation with engineers who are laser-focused on getting things to work in a timely manner can be challenging. We always manage to sort it out, though, and it’s often just a little collaborative effort that takes it to that sublime intersection of design and technology. In the end, the sense of pride when we gather around a finished product is truly like none other.


For more Steven Heller, check out Design Literacy: Understanding Graphic Design—one of the many Heller titles available at