Objective
To analyze ambulatory movements and team dynamics during robot-assisted surgery (RAS), and investigate whether congestion of the physical space associated with RA technology led to workflow challenges, or predisposed to errors and adverse events.
Methods
With IRB approval, we retrospectively reviewed 10 recorded RA radical prostatectomies in a single operating room (OR). OR was divided into 8 zones, and all movement were tracked and described in terms of start and end zones, duration, personnel, and purpose. Movement were further classified into avoidable (can be eliminated/improved) and unavoidable (necessary for completion of the procedure).
Results
Mean operative time was 166 minutes, of which ambulation constituted 27 minutes (16%). A total of 2,896 ambulatory movements were identified (mean=290 ambulatory movements/procedure). Most of movements were procedure-related (31%), and were performed by the circulating nurse. We identified 11 main pathways in the OR (Figure 1); the heaviest traffic was between the Circulating Nurse Zone, Transit Zone and Supply-1 Zone. Fifty percent of ambulatory movements were found to be avoidable.
Conclusion
More than half of the movements during RAS can be eliminated with an improved OR setting. More studies are needed to design an evidence-based OR layout that enhances access, workflow and patient safety.
Even in experienced hands the long-term complications of robot-assisted radical cystectomy are notable. Of our patients 23% required surgical interventions after the procedure. Our initial experience with robot-assisted management of robot-assisted radical cystectomy complications appears safe and feasible, although the decision to proceed is determined primarily by surgeon experience.
This study objectively evaluated the cognitive engagement of a surgical mentor teaching technical skills during surgery. The study provides a deeper understanding of how surgical teaching actually works and opens new horizons for assessment and teaching of surgery. Further research is needed to study the feasibility of this novel concept in assessment and guidance of surgical performance.
Objective
To prove Inguinal mesh hernioplasty under L/A is safe and acceptable. Helps with post-operative pain and enables rapid recovery as a day case.
Method
All patients who underwent inguinal hernia repair under local anaesthesia were retrospectively analysed in our hospital between July 2014- July 2017. Clinical judgement was used for inclusion and exclusion parameters.
Results
From July 2014- July 2017, 260 patients were included in study who underwent Inguinal mesh hernioplasty under L/A. ASA grade for all patients ranged between I-III. The mean age was 37 (20-65). Intraoperatively (9.1) 3.5% patients had problems such as pain, hypotension or sweating. About (86.3%) 224 patients were discharged home the same day and remaining stayed overnight for less than 24 hours. Hematoma was seen in 5 (1.92%) patients, Urinary retention in 2 (0.7%) patients, Wound infection seen in 24(9.2%) patients, Readmission in 10 (3.8%) patients. Chronic groin pain was seen in 10 (3.9%) patients and no recurrence on 6 months follow up.
Conclusions
Our results showed that this procedure is feasible under L/A and can be performed safely. It showed satisfactory acceptance by the operating surgeon and patient, without significant perioperative issues. It is reliable and showed shorter hospital stay.
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