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

Raheem, Sana; Ahmed, Youssef; Hussein, Ahmed A.; Johnson, Amanda; Cavuoto, Lora; May, Paul; Cole, Adam; Wang, Derek; Ahmad, Basim; Hasasneh, Adam

doi:10.1111/bju.14150

Cited by 23 publications

(28 citation statements)

References 23 publications

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“…Several of the included studies were conducted by the same research group (i.e., overlapping authors). Five studies investigating communication that came from the same research group were included in this review (Raheem et al, 2018; Sexton et al, 2018; Tiferes, Bisantz, et al, 2016, 2019, Tiferes, Hussein, et al, 2016): these articles were used to identify communication requirements and patterns during robotic-assisted surgery. Communication was also investigated during open and laparoscopic procedures in work by Sevdalis et al (2007, p. 2012), who used frequency of communication events to quantify case-irrelevant conversations and overall communication in the OR.…”

Section: Resultsmentioning

confidence: 99%

“…Although observer dependent, such studies were included in this review as they quantified communication metrics. Studies reported a range of agreement between 0.74 and 0.98 (Keller et al, 2016; Raheem et al, 2018; Sevdalis et al, 2012; Sexton et al, 2018; Tiferes, Bisantz, et al, 2016, p. 10; Tiferes et al, 2019; Weigl et al, 2018), which is typically considered as substantial agreement (McHugh, 2012).…”

Section: Resultsmentioning

confidence: 99%

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Objective Measures of Surgeon Non-Technical Skills in Surgery: A Scoping Review

Cha

2021

Hum Factors

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Objective The purpose of this study was to identify, synthesize, and discuss objective behavioral or physiological metrics of surgeons’ nontechnical skills (NTS) in the literature. Background NTS, or interpersonal or cognitive skills, have been identified to contribute to safe and efficient surgical performance; however, current assessments are subjective, checklist-based tools. Intraoperative skill evaluation, such as technical skills, has been previously utilized as an objective measure to address such limitations. Methods Five databases in engineering, behavioral science, and medicine were searched following PRISMA reporting guidelines. Eligibility criteria included studies with NTS objective measurements, surgeons, and took place within simulated or live operations. Results Twenty-three articles were included in this review. Objective metrics included communication metrics and measures from physiological responses such as changes in brain activation and motion of the eye. Frequencies of content-coded communication in surgery were utilized in 16 studies and were associated with not only the communication construct but also cognitive constructs of situation awareness and decision making. This indicates the underlying importance of communication in evaluating the NTS constructs. To synthesize the scoped literature, a framework based on the one-way communication model was used to map the objective measures to NTS constructs. Conclusion Objective NTS measurement of surgeons is still preliminary, and future work on leveraging objective metrics in parallel with current assessment tools is needed. Application Findings from this work identify objective NTS metrics for measurement applications in a surgical environment.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Objective Measures of Surgeon Non-Technical Skills in Surgery: A Scoping Review

Cha

2021

Hum Factors

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“…Presently, traditional systems use rigid suction cannulas that make access to some narrow spaces difficult while also demanding good communication between surgeon and a skilled bedside assistant. 10,11 An articulating robotic instrument for suction was introduced for the da Vinci Si robot in 2013 with the same instrument also currently available on the Xi robot, but there has not been any significant adoption most likely because this occupies one of the four robotic arms that could be used for other instruments.…”

Section: Discussionmentioning

confidence: 99%

Impact of Surgeon-Controlled Suction During Robotic Prostatectomy to Reduce Dependence on Bedside Assistance

Martínez

Murphy

Bsatee

et al. 2021

Journal of Endourology

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Background: Suction during robotic surgery has traditionally been performed by a bedside assistant. Adequately skilled assistants are not always available. We assessed a purpose-designed robotic surgeon-controlled suction catheter for efficiency and safety by comparing with historic cases of suction controlled by a dedicated bedside assistant using standard rigid laparoscopic suction. Methods: Beginning in February 2019, the remotely operated suction irrigation (ROSI) device was used in all robotic prostatectomy procedures, which is a flexible suction catheter manipulated by the surgeon such that a bedside assistant is never required for suction. The initial 300 consecutive cases performed with ROSI were compared with the 300 immediately previous procedures using bedside assistant suction (BAS). Results: There were no statistically significant differences between groups in age, body mass index, American Anesthesiologist Association score, prostate specific antigen, or pathologic stage. Lymph node dissection was performed in all 600 patients. All 300 ROSI cases were completed without requiring switching to BAS. Estimated blood loss (102.7 vs 120.2 mL, p = 0.001) and operative time (156.1 vs 149.3 minutes, p < 0.001) were slightly lower in the ROSI group. There was no statistical difference in the 90-day complication rate (Clavien ‡III) between groups, with both having 3% of patients readmitted or seen in the emergency department within 90 days of surgery. Conclusion: Surgeon-controlled suction allowed more surgeon autonomy without a negative impact on efficiency or safety issues requiring ''bailout'' suctioning by the bedside assistant whether urgent or otherwise. Robotic surgeons without access to skilled bedside assistants should consider suctioning for themselves not unlike the norm for many laparoscopic surgeons.

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“…All were published between 2004 and 2020 (median: 2017). Eleven studies were conducted in the US, [15,17,[27][28][29][30][31][32][33][34][35], six in the UK [18,[36][37][38][39][40], and four in Western/Northern European countries [22,[41][42][43]. Studies either examined one [18,22,28,32,41] or several OR professions [15, 17, 27, 29-31, 33-40, 42, 43].…”

Section: Characteristics Of Included Articlesmentioning

confidence: 99%

RAS-NOTECHS: validity and reliability of a tool for measuring non-technical skills in robotic-assisted surgery settings

et al. 2021

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Background Non-technical skills (NTS) are essential for safe surgical practice as they impact workflow and patient outcomes. Observational tools to measure operating room (OR) teams’ NTS have been introduced. However, there are none that account for the specific teamwork challenges introduced by robotic-assisted surgery (RAS). We set out to develop and content-validate a tool to assess multidisciplinary NTS in RAS. Methodology Stepwise, multi-method procedure. Observations in different surgical departments and a scoping literature review were first used to compile a set of RAS-specific teamwork behaviours. This list was refined and expert validated using a Delphi consensus approach consisting of qualitative interviews and a quantitative survey. Then, RAS-specific behaviours were merged with a well-established assessment tool on OR teamwork (NOTECHS II). Finally, the new tool—RAS-NOTECHS—was applied in standardized observations of real-world procedures to test its reliability (inter-rater agreement via intra-class correlations). Results Our scoping review revealed 5242 articles, of which 21 were included based on pre-established inclusion criteria. We elicited 16 RAS-specific behaviours from the literature base. These were synthesized with further 18 behavioural markers (obtained from 12 OR-observations) into a list of 26 behavioural markers. This list was reviewed by seven RAS experts and condensed to 15 expert-validated RAS-specific behavioural markers which were then merged into NOTECHS II. For five observations of urologic RAS procedures (duration: 13 h and 41 min), inter-rater agreement for identification of behavioural markers was strong. Agreement of RAS-NOTECHS scores indicated moderate to strong agreement. Conclusions RAS-NOTECHS is the first observational tool for multidisciplinary NTS in RAS. In preliminary application, it has been shown to be reliable. Since RAS is rapidly increasing and challenges for effective and safe teamwork remain at the forefront of quality and safety of surgical care, RAS-NOTECHS may contribute to training and improvement efforts in technology-facilitated surgeries.

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

Abstract: To our knowledge, this is the first study to provide a detailed analysis of communication during RAS. It lays a foundation for standardized taxonomy to improve communication, surgical efficiency and patient safety.

Cited by 23 publications

References 23 publications

Objective Measures of Surgeon Non-Technical Skills in Surgery: A Scoping Review

Objective Measures of Surgeon Non-Technical Skills in Surgery: A Scoping Review

Impact of Surgeon-Controlled Suction During Robotic Prostatectomy to Reduce Dependence on Bedside Assistance

RAS-NOTECHS: validity and reliability of a tool for measuring non-technical skills in robotic-assisted surgery settings

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