No abstract

No abstract

We described our step-by-step technique and initial perioperative outcomes of our first five ICNBs with 'W' configuration.

Objective To analyze ambulatory movements and team dynamics during robot-assisted surgery (RAS), and investigate whether congestion of the physical space associated with RA technology led to workflow challenges, or predisposed to errors and adverse events. Methods With IRB approval, we retrospectively reviewed 10 recorded RA radical prostatectomies in a single operating room (OR). OR was divided into 8 zones, and all movement were tracked and described in terms of start and end zones, duration, personnel, and purpose. Movement were further classified into avoidable (can be eliminated/improved) and unavoidable (necessary for completion of the procedure). Results Mean operative time was 166 minutes, of which ambulation constituted 27 minutes (16%). A total of 2,896 ambulatory movements were identified (mean=290 ambulatory movements/procedure). Most of movements were procedure-related (31%), and were performed by the circulating nurse. We identified 11 main pathways in the OR (Figure 1); the heaviest traffic was between the Circulating Nurse Zone, Transit Zone and Supply-1 Zone. Fifty percent of ambulatory movements were found to be avoidable. Conclusion More than half of the movements during RAS can be eliminated with an improved OR setting. More studies are needed to design an evidence-based OR layout that enhances access, workflow and patient safety.

No abstract