Ambulatory movements, team dynamics and interactions during robot‐assisted surgery

Abstract

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.

Variability and interpretation of communication taxonomy during robot‐assisted surgery: do we all speak the same language?

“…3). A significant difference in total action time was found between complete and incomplete requests (median [interquartile range] 8 [4][5][6][7][8][9][10][11][12][13][14][15] s vs 5 [2-11] s; P < 0.001). There were no significant differences in terms of inconveniences (P = 0.57) and acknowledgments (P = 0.72).…”

“…Communication in RAS is challenging because of the congestion of equipment and the altered operating theatre dynamics, with isolation of the surgeon on the console away from the patient and the bedside assistants [4,5,7,26]. The Agency for Healthcare Research and Quality recommended against the use of non-verbal communication because of its Acknowledgement P = 0.02 Fig.…”

“…RAS offers improved peri-operative outcomes, such as reduced blood loss, fewer blood transfusions, shorter hospital stay and quicker recovery, without jeopardizing outcomes [2]. For surgeons, the robot provides improved dexterity, shorter learning curves, superior precision and visualization, and better accessibility to deeper anatomical locations compared with the open approach [3]; however, the introduction of any new technology like RAS also brings new challenges; the operating theatre environment and the spatial arrangement of the patient and the surgical team is different from those of the traditional open approach [4][5][6]. Cluttering of equipment, wires and the remote placement of the surgeon at the surgical console away from the patient and surgical team may change the dynamics of communication and may affect some interpersonal cues among the surgical team [5,[7][8][9].…”

Barriers to efficiency in robotic surgery: the resident effect

“…no nephrectomies involved residents, while all sacrocolpopexies involved residents). Although the sample size is large in comparison to similar observational studies [23,24], and we believe that we controlled for procedure type as much as possible in our analysis and statistics, our conclusions were nevertheless limited. Follow-up studies will seek a more structured selection of cases in order to decrease this bias.…”

Diagnosing barriers to safety and efficiency in robotic surgery

“…As the surgeon works at a console away from the operating table, this can degrade the shared understanding amongst the team members of the surgical progress and requirements that demands new approaches to teamwork, communication and situation awareness (Randell et al 2016). Even the required size and layout of the room is altered by the size of the robot, associated control consoles and the data and power cables necessary for function (Ahmad et al 2016; Allers et al 2016). This means that a limited number of ORs in any surgical suite may be suitable for robotic surgery.…”