Diagnosing barriers to safety and efficiency in robotic surgery

Abstract

Recent studies exploring the effects of surgical robots on teamwork are revealing challenges not reflected in clinical studies. This study is a sub analysis of observational data collected from 89 procedures utilising the da Vinci systems. Previous analyses had demonstrated interactions between flow disruptions and contextual factors. This study sought a more granular analysis to provide better insight for improvement. Raters sub-classified disruptions, based upon the original notes, grouped according to four operative phases (pre-robot; docking; surgeon on console; undocking; and finish). The need for repeated utterances; additional supplies retrieval; fogging or matter on the endoscope and procedure-specific training were particularly disruptive. Variations across phases reflect differing demands across the operative course. Combined qualitative and quantitative observational methodologies can identify otherwise undocumented sources of process variation and potential failure. Future observational frameworks should attempt to merge human reliability analysis, a priori modelling, and post hoc analyses of observational data. Practioner Summary Robotic surgery introduces new challenges into the operating room. Direct observation was used to classify and identify flow disruptions in order to diagnose problems in need of improvement. This technique complements other error prediction and system diagnostic methods which may not account for the complexity and transparency of health care.

Systematic review of team performance in minimally invasive abdominal surgery

“…Two studies investigated the influence of a non‐technical skills training intervention on surgical team performance. Four studies consisted of subanalyses of results from observed cohorts published in previous work ( Table S1, supporting information).…”

“…All studies observed complete surgical teams (including surgery, anaesthesia and nursing staff) with the goal of evaluating team performance through surgical workflow analysis and evaluation of disruptive events (9 studies), the relationship between team performance and technical outcomes (3 studies), the relationship between anticipation of surgical steps and team efficiency (1 study) or novel tools to rate team performance (3 studies).…”

“…No study compared robot‐assisted techniques with other approaches. Five studies investigated robot‐assisted techniques and found that this approach to abdominal procedures increases team demands that surgical teams were not always able to address effectively, resulting in increased operating times. The identification and analysis of flow disruptions can provide an evidence base for improving the efficiency and safety of robot‐assisted procedures ( Table S1, supporting information).…”

“…No study compared robot-assisted techniques with other approaches. Five studies investigated robot-assisted techniques and found that this approach to abdominal procedures increases team demands 24 that surgical teams were not always able to address effectively 20 , resulting in increased operating times 27 .…”

Anesthesia Professionals’ Perspectives of Teamwork During Robotic‐Assisted Surgery

“…However, good teamwork can be difficult to achieve. One study found that levels of team skills varied among three different disciplines on a surgical team (ie, surgeons, anesthesia professionals, perioperative nurses) . A recent review indicates that communication and coordination problems frequently occur during RAS …”