Key result
Direct observation of robotic surgeries identifies flow disruptions including supply retrieval and endoscope fogging.
Why the study?
Recent studies reveal challenges in teamwork during robotic surgery not captured by clinical studies, necessitating detailed analysis of flow disruptions.
Observational (n=89)
Direct observation and granular classification of flow disruptions in robotic surgery can identify specific, phase-dependent barriers to safety and efficiency.
May inform targeted workflow interventions in robotic surgery; leaves open effects on safety and efficiency.
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.
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Hallett et al. (2017) conducted an observational in Robotic surgery (n=89). Robotic surgery (da Vinci systems) was evaluated on Flow disruptions. Direct observation of 89 da Vinci robotic surgery procedures identified flow disruptions including repeated utterances, supplies retrieval, endoscope fogging, and procedure-specific training needs.
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