Impaired robotic surgical visualization: archaic issues in a modern operating room

Abstract

BackgroundWhile Robotic-Assisted Surgery (RAS) has been revolutionizing surgical procedures, it has various areas needing improvement, speci cally in the visualization sector. Suboptimal vision due to lens occlusions has been a topic of concern in laparoscopic surgery but has not received much attention in robotic surgery. This study is the rst to explore and quantify the degree of disruption encountered due to poor robotic visualization at a major academic center. MethodsIn case observations across 21 RAS procedures in various specialties, any lens occlusions or "debris" events that appeared on the monitor displays and clinicians' reactions, the cause, and the location across the monitor for these events were recorded. Data was then assessed for any trends using analysis as described below. ResultsFrom around 32 hours of RAS observation time, 124 debris events were recorded. 58.7% of case observation time was spent under a compromised visual eld (p = 0.037). In a subset of 8 cases, about 1.4% of the average observation time was spent cleaning the lens. Additionally, cautery was found to be the primary cause of lens occlusions and little variation was found within the spread of the debris across the monitor display. ConclusionsThis study illustrates that in 6 (29%) of the cases, 90% of the observation time was spent under compromised visualization while only 9.5% of the cases had no debris or cleaning events. Additionally, cleaning the lens can be troublesome during the procedure, interrupting the operating room ow. This paper suggests areas for research and technological development.