The Impact of Robotic-Assisted Surgery on Team Performance: A Systematic Mixed Studies Review

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p> The aim of this study is to describe the impact of robotic-assisted surgery on team performance in the operating room. </jats:p></jats:sec><jats:sec><jats:title>Background</jats:title><jats:p> The introduction of surgical robots has improved the technical performance of surgical procedures but has also contributed to unexpected interactions in surgical teams, leading to new types of errors. </jats:p></jats:sec><jats:sec><jats:title>Method</jats:title><jats:p> A systematic literature search of Cumulative Index to Nursing and Allied Health Literature, PubMed, ProQuest, Cochrane, Web of Science, PsycINFO, and Scopus databases using key words and MeSH terms was conducted. Screening identified studies employing qualitative and quantitative methods published between January 2000 and September 2019. Two reviewers independently appraised the methodological quality of the articles using the Mixed Methods Appraisal Tool (2018). Discussions were held among authors to examine quality scores of the studies and emergent themes, and agreement was reached through consensus. Themes were derived using inductive content analysis. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Combined searches identified 1,065 citations. Of these, 19 articles, 16 quantitative and 3 qualitative, were included. Robotic-assisted surgeries included urology, gynecology, cardiac, and general procedures involving surgeons, anesthetists, nurses, and technicians. Three themes emerged : Negotiating the altered physical environs and adapting team communications to manage task and technology; managing the robotic system to optimize workflow efficiency; and technical proficiency depends on experience, team familiarity, and case complexity. </jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p> Inclusion of a robot as a team member adds further complexity to the work of surgery. </jats:p></jats:sec><jats:sec><jats:title>Application</jats:title><jats:p> These review findings will inform training programs specifically designed to optimize teamwork, workflow efficiency, and learning needs. </jats:p></jats:sec>

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

“…In the future, methodological quality of included studies may be evaluated and taken into account. In fact, a previous systematic review on a topic comparable to ours concluded that the available literature base on NTS within RAS has methodological limitations [ 16 ].…”

“…For example, the console surgeon and assistant surgeon can communicate via the screen either using their instruments to point at important areas in situ [ 15 ] or by using telestration [ 53 ]. Additionally, as each OR team member is able to observe the progression of the surgery on the screen, the team’s shared situation awareness increases [ 16 ].…”

“…In the past decade, there has been a tremendous growth in the use of robotic technologies. Yet, RAS adds unique challenges—both technical and non-technical—compared to conventional surgery [ 15 , 16 ]. During RAS procedures, one surgeon spends much of the operating time on the console, separated from both the patient and the remaining OR team.…”

“…Other OR team professionals may face challenges with the robot arms obstructing their view of one another. But apart from impeding communication and coordination, RAS also facilitates new modes of nonverbal communication, e.g., with the display as a mediator, providing visual access to all OR team members and allowing for visual communication between the console surgeon and the assistant surgeon [ 16 , 17 ]. Consequently, available OR teamwork tools may not be sufficiently valid to evaluate NTS in RAS, as they do not take into account RAS-specific behaviours and unique demands [ 6 ].…”

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

“…Some hospitals have one team of surgeons, nurses and anesthesiologists that performs mostly robotic interventions, which enables them to become highly specialized. Other institutions do not have dedicated robotic teams; this decreases exposure to robotic surgery [ 13 , 14 ], and makes it more difficult to maintain expertise and train new surgeons in robotic procedure completion. In fact, many have argued that a sufficient volume of cases is a prerequisite for an adequate robotic training and stable level of competence [ 15 , 16 ].…”