Surgeon-Team Separation in Robotic Theaters: A Qualitative Observational and Interview Study

Abstract

Background The rapid uptake of robotic surgery has largely been driven by the improved technical aspects of minimally invasive surgery including improved ergonomics, wristed instruments, and 3-dimensional vision. However, little attention has been given to the effect of physical separation of the surgeon from the rest of the operating team. Purpose The aim of this study was to examine in depth how this separation affected team dynamics and staff emotions. Methods Robotic procedures were observed in 2 tertiary hospitals, and laparoscopic/open procedures were added for comparison; field notes were taken instantaneously. One-to-one interviews with theater team members were audio recorded and transcribed verbatim. Qualitative analysis was conducted via grounded theory approach using NVIVO11. Results Twenty-nine participants (26 interviewed) were recruited to the study (11 females) and 134 (109 robotic) hours of observation were completed across gynecology, urology, and colorectal surgery. The following 3 main themes emerged with compounding factors identified: (a) communication challenge, (b) immersion versus distraction, and (c) emotional impact. Compounding factors included the following: individual and team experience, staffing levels, and the physical theater environment. Conclusions Our emergent theory is that “surgeon-team separation in robotic theaters poses communication challenges which impacts on situational awareness and staff emotions.” These can be ameliorated by staff training, increased experience, and team/procedure consistency.

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

“…Eleven studies were conducted in the US, [ 15 , 17 , 27 – 35 ], six in the UK [ 18 , 36 – 40 ], and four in Western/Northern European countries [ 22 , 41 – 43 ]. Studies either examined one [ 18 , 22 , 28 , 32 , 41 ] or several OR professions [ 15 , 17 , 27 , 29 – 31 , 33 – 40 , 42 , 43 ]. The majority investigated only one surgical specialty [ 17 , 18 , 27 – 30 , 33 – 35 , 38 ].…”

“…The majority investigated only one surgical specialty [ 17 , 18 , 27 – 30 , 33 – 35 , 38 ]. Eight studies focused on da Vinci surgical systems (Intuitive Inc., CA) [ 18 , 27 , 36 , 37 , 40 – 43 ], one examined Brock Rogers Surgical Laprotek System [ 29 ].…”

“…While we aimed to identify behaviours indicating good or poor teamwork, we found that some were only applicable if a negative behaviour or event preceded, i.e., actually compensated for obstacles of the robotic setup [ 15 , 35 , 37 , 40 ]: for example, ‘surgeon pulls head out of console or walks up to operating table if communication with team is difficult’ or ‘OR team member asks if uncertain who was addressed’ can be considered as a necessary rectification of a suboptimal condition. Since we consider OR professional’s adequate and effective adaption to evolving challenges an important NTS, these behavioural markers were kept.…”

“…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].…”

Teaching and learning robotic surgery at the dual console: a video-based qualitative analysis

“…Robotic surgery also radically transforms the operating room’s spatial configuration, creating a distance between the lead surgeon at the console and the other operating team members at the bedside or the second console. It has been suggested that this distance may impede effective teaching [ 19 ], particularly by hampering non-verbal communication.…”