Robotic Instrumentation, Personnel and Operating Room Setup

A realist process evaluation of robot-assisted surgery: integration into routine practice and impacts on communication, collaboration and decision-making

“…147 The scrub practitioner and circulating practitioner need to acquire new skills and need to learn their part in draping and docking the robot, how to change instruments, and troubleshooting. 164,165 The first assistant will need to learn all of this, as well as have an understanding of basic laparoscopic surgery. Specific training for first assistants, involving dry-laboratory training, personal instruction sessions, videos and surgery observation, was described.…”

“…One strategy was to have a dedicated robotic team [114][115][116]152,154,170,[181][182][183] that can 'work through the learning curve and, if possible, all robotic cases'. 164 The underlying theory is that by working through all robot-assisted cases, the team more quickly becomes familiar and confident with the equipment and tasks associated with setting up the robot, allowing team members to complete the necessary tasks more quickly, reducing set-up time. Although typically discussed in relation to the surgeon's learning curve, 184 the theory suggests that the number and frequency of robot-assisted operations that take place within the organisation are contextual factors that impact the effectiveness of this strategy.…”

“…186 The use of directional cues is considered to be problematic in RAS, potentially resulting in confusion, time-wasting and patient injury. 164 This problem occurs, presumably, because the separation means that team members do not have the same physical context as the surgeon to understand such deictic instructions and, again, the surgeon is unable to support those instructions with gestures.…”

“…Some authors argued that communication between the surgeon and first assistant is particularly important in RAS, especially during instrument exchanges, when failure in communication could lead to 'inadvertent adjustment, movement and complete removal of an instrument that is in use'. 164 However, it has also been argued that less co-ordination and communication may be required between the surgeon and the first assistant because the surgeon controls the camera and, if four robotic arms are used, can do more of the retraction (instead of this being done by the first assistant). 157,187 Strategies for overcoming the communication challenges focused on the use of standardised communication.…”

Two-way least-incision transformable end-effector forceps for robot-assisted surgery

“…The forceps was attached to the experimental device, in which three disks were rotated using the motor. The rotary speed produced allowed the experimental device to perform transformation in 6 s. An environment that mimicked a robot-assisted surgery environment was created as described in a previous study [11]. Five subjects (non-specialists) performed instrument exchanges six times in this environment, and the exchange times were measured.…”