A Quality Improvement Project for–Safe and Effective Patient Positioning During Robot‐Assisted Surgery

Abstract

During the initiation of a new robotic surgery program, a quality improvement team explored different techniques for positioning patients in the lithotomy and steep Trendelenburg position during robot-assisted procedures. Concerns associated with placing patients in the steep Trendelenburg position include the patient slipping toward the head of the bed and experiencing hemodynamic changes that may result in a rise in blood pressure, increased intraocular and intracranial pressures, and difficulty with ventilation, particularly in patients with a high body mass index. Skin integrity is also of concern because perioperative personnel are responsible for protecting the patient's skin from excessive sheer, friction, and injury. The quality improvement team evaluated and compared two positioning devices: an air-inflated positioning device and high-density foam padding. Both methods allowed personnel to position the patient without compromise; the surgeons performing the robot-assisted procedures preferred the high-density foam padding.

Perioperative Nurses’ Work Experience With Robotic Surgery

“…They positioned patients using verified safety devices, such as air-inflated positioning devices and high-density foam padding, 12 because improper positioning and padding for surgery can result in skin pressure, nerve pressure, and venous thrombosis. 12 Thus, nurses play an important role in building the culture of safety in robotic surgery; however, the increased work speed and inadequate staffing in the operating room might cause safety problems. 18 When safety problems occur, psychological and financial burden to patients, family, clinicians, and institutions will also be increased.…”

“…8 For example, various patient positions such as steep Trendelenburg and lithotomy positions involved in robotic surgery require proper technique, awareness, and appropriate use of effective positioning devices (eg, air-inflated positioning devices and high-density foam padding for robotic surgery) in order to prevent position-related injuries. 12 Operating room nurses are required to learn about new technologies and may face challenges related to learning new skills and playing expanded roles related to innovative surgical robots. They must be well prepared for any emergent situation.…”

Patient‐reported extremity symptoms after robot‐assisted laparoscopic cystectomy

“…The incidence of injuries may increase with the wide expansion of robotic procedures requiring a steep Trendelenburg position and long surgery time. Evidence‐based methods for positioning and revised local guidelines may increase patient comfort and reduce the incidences of pressure injuries not least for surgery in steep Trendelenburg position (Sutton et al, ). However, with reference to our study, it is of greatest interest and importance to have structured routines for performing preoperative assessments of every patient's individual needs and health status, and pre‐ and postoperative documentation in the patient record.…”

“…Body straps with shoulder braces, egg-crate foam or bean bag are common ways to fixate the patient (Sotelo et al, 2016). Commonly, both arms are tucked and padded along the body to avoid hyperabduction of the upper limbs, and for preventing the articulating robotic arms from causing any pressure to the patient (Sutton, Link, & Makic, 2013).…”

Operating theatre nurse specialist competence to ensure patient safety in the operating theatre: A discursive paper

“…They also prevent the risk of retained surgical items, medical errors and failures in instrument reprocessing (Steelman et al, 2013). The continual development of new high-tech equipment, such as surgical robots, seems to require even more caring skills of the OT nurse to prevent injuries related to the equipment (Sutton, Link, & Makic, 2013…”