Impact of bedside assistant on outcomes of robotic thyroid surgery

Abstract

The importance of bedside assistants has been well established in various robotic procedures. However, the effect of assistants on the surgical outcomes of thyroid surgery remains unclear. We investigated the effects of a dedicated robot assistant (DRA) in robotic thyroidectomy. We also evaluated the learning curve of the DRA. Between January 2016 and December 2019, 191 patients underwent robotic total thyroidectomy, all of which were performed by a single surgeon. The DRA participated in 93 cases, while non-dedicated assistants (NRAs) helped with 98 cases. Demographic data, pathologic data, operative times, and postoperative complications were recorded and analyzed. Robotic thyroidectomy was successful in all 191 patients, and none required conversion to the conventional open procedure. Mean operative time was shorter in the DRA group than in the NRA group (183.2 ± 33.6 minutes vs 203.1 ± 37.9 minutes; P < .001). There were no significant differences in terms of sex distribution, age, preoperative serum thyroid stimulating hormone level, or pathologic characteristics between the groups. Cumulative summation analysis showed that it took 36 cases for the DRA to significantly reduce operative time. Mean operative time decreased significantly in the subgroup including the 37th to the 93rd DRA cases compared with the subgroup including only the first 36 DRA cases (199.7 ± 37.3 minutes vs 172.8 ± 26.4 minutes; P < .001). NRA group showed no definite decrease of operation time, which indicated that the NRAs did not significantly deviate from the mean performance. Increased experience of the bedside assistant reduced operative times in the robotic thyroidectomy. Assistant training should be considered as a component of robotic surgery training programs.

Experience matters for robotic assistance: an analysis of case data

“…In contrast, three other studies in prostatectomy and nephrectomy involving a combined 636 patients showed no effect on patient outcomes or case length based on the experience of the assistant [ 18 , 20 , 21 ]. Studies of the impact of assistants in 191 robotic-assisted thyroid operations and 105 robotic-assisted Nissen fundoplications came to conflicting results [ 22 , 23 ]. Our work adds to this literature with a much larger sample size of real-world, diverse cases in multiple specialties with various types of assistants.…”

“…The effect of operative assistant experience on outcomes has been widely studied in many settings, with different results by procedure, institution, and publication [3,[12][13][14][15][16][17][18][19][20][21][22][23]. Most of the existing literature on the effect of the assistant in robotic surgery is limited to robotic-assisted prostatectomy and nephrectomy.…”

The role of the bedside assistant in robot-assisted surgery: A critical synthesis

“…Intraoperatively, the BA is physically located next to the patient, standing or sitting next to the operating table, while the operating surgeon stands or sits at the separate robot console. The BA’s autonomous performance is therefore critical, according to extensive literature (Collins et al 2021, Kwon 2020, Potretzke et al 2016), not only ensuring the initiation, continuance and successful completion of the procedure but also due to the primary responsibility for the safety of the patient, as argued by Kumar et al (2015). The importance of the role seems closely related to the tasks and activities undertaken, as well as to communication in RAS.…”