Technology has revolutionised surgery in minimising anatomical invasiveness and increasing the range of surgical interventions available. However, modern remote and robot assisted surgery places unorthodox demands on surgeons and on all those involved in surgical operations in the operating theatre/room. This system of work is of vital importance to surgical success. However, research for developing surgical technique focuses mainly on the surgeon’s interface with the operative site, neglecting the operating room system supporting that technique. Furthermore, there is yet no agreement on the framework for regularly organising this vital system and for optimising its design for interprofessional work. By expanding on the conventional human–machine interface, we develop a model depicting the surgeon controlling surgical action through the media and technology of the operating room system. We show how the operating room team mediate the control of the surgical operation. By viewing control and communication in the operating room as a property of a distributed or joint cognitive system, we emphasise the potential for the team, their media and technology to either impair or enhance surgical performance.