Effective communication and teamwork are vital in high-stakes environments such as the operating room, where timely and accurate information exchange directly affects patient safety and surgical outcomes. Among intraoperative interactions, the collaboration between the surgeon and anesthesiologist is especially critical for maintaining smooth workflows and preventing adverse events. Despite its importance, little HCI research has explicitly examined the unique needs of this dyad or how AI-driven supportive systems might be designed to address them. In this work, we present a qualitative study of surgeon–anesthesiologist collaboration, drawing on focus groups with both specialties and in-situ observations of 45 surgeries spanning open, laparoscopic, and robotic procedures. Our findings uncover key challenges, unmet needs, and coordination breakdowns that shape this relationship. Based on these insights, we conceptualize a systems design to better support intraoperative collaboration.

The integration of Augmented Reality (AR) technology into surgical procedures offers significant potential to enhance clinical outcomes. While there are plenty of lab-proven prototypes, systems employed in actual clinical settings require specialized design and rigorous clinical evaluation of these AR-based solutions to meet the high demands of complex medical fields. Our research exposes these complex requirements emerging from clinical environments, such as operation theaters. To address the challenges, we introduce ARAS, an operational AR assistance system for live open pancreatic surgery. Employing a user-centric design methodology, we designed and refined ARAS through several iterations, ensuring its practical applicability and effectiveness in a real-world surgical setting during clinical trials. ARAS enables in situ and precise visualization of the patient’s 3D reconstructed vascular system and tumor during the surgical procedure. We evaluated ARAS through clinical trials (N=7) involving patients diagnosed with pancreatic cancer. Our interviews with the surgeons underscored the utility of ARAS for open pancreatic surgery, especially in critical and highly time-pressured phases of the surgery, as it proved to be exceptionally beneficial in aiding surgeons during in their decision-making process. In a post-surgery evaluation, the surgeons also certified the precise visualization accuracy of ARAS during those critical phases. Our findings showcased the heightened requirements for AR-based solutions in operational clinical use and proved that ARAS met the challenges emerging during live surgeries. Consequently, surgical AR assistance systems do have a transformative potential to revolutionize traditional practices, but their applicability is subject to high design constraints during critical medical procedures.