The safety of urologic robotic surgery depends on the skills of the surgeon

Palagonia, Erika; Mazzone, Elio; Naeyer, Geert De; D’Hondt, Frederiek; Collins, Justin; Wisz, Pawel; Leeuwen, Fijs W. B. van; Poel, Henk van der; Schatteman, Peter; Mottrie, Alexandre; Dell’Oglio, Paolo

doi:10.1007/s00345-019-02901-9

Cited by 28 publications

(16 citation statements)

References 77 publications

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“…The increasing use of robot‐assisted technology for surgery imposes the need to set standardised training pathways to optimise patient care and safety [ 24 , 25 , 26 ]. As such, to improve patient outcomes after RARP, robotic training and education needs to be modernised and augmented.…”

Section: Discussionmentioning

confidence: 99%

Objective assessment of intraoperative skills for robot‐assisted radical prostatectomy (RARP): results from the ERUS Scientific and Educational Working Groups Metrics Initiative

et al. 2020

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Objective To develop and seek consensus from procedure experts on the metrics that best characterise a reference robot‐assisted radical prostatectomy (RARP) and determine if the metrics distinguished between the objectively assessed RARP performance of experienced and novice urologists, as identifying objective performance metrics for surgical training in robotic surgery is imperative for patient safety. Materials and methods In Study 1, the metrics, i.e. 12 phases of the procedure, 81 steps, 245 errors and 110 critical errors for a reference RARP were developed and then presented to an international Delphi panel of 19 experienced urologists. In Study 2, 12 very experienced surgeons (VES) who had performed >500 RARPs and 12 novice urology surgeons performed a RARP, which was video recorded and assessed by two experienced urologists blinded as to subject and group. Percentage agreement between experienced urologists for the Delphi meeting and Mann–Whitney U‐ and Kruskal–Wallis tests were used for construct validation of the newly identified RARP metrics. Results At the Delphi panel, consensus was reached on the appropriateness of the metrics for a reference RARP. In Study 2, the results showed that the VES performed ~4% more procedure steps and made 72% fewer procedure errors than the novices (P = 0.027). Phases VIIa and VIIb (i.e. neurovascular bundle dissection) best discriminated between the VES and novices. Limitations: VES whose performance was in the bottom half of their group demonstrated considerable error variability and made five‐times as many errors as the other half of the group (P = 0.006). Conclusions The international Delphi panel reached high‐level consensus on the RARP metrics that reliably distinguished between the objectively scored procedure performance of VES and novices. Reliable and valid performance metrics of RARP are imperative for effective and quality assured surgical training.

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Section: Discussionmentioning

confidence: 99%

Objective assessment of intraoperative skills for robot‐assisted radical prostatectomy (RARP): results from the ERUS Scientific and Educational Working Groups Metrics Initiative

et al. 2020

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“…The learning curve for the rest of the surgical team encompasses the technology itself, mastering a new vocabulary to communicate, and adjusting to new tasks and responsibilities (Randell et al, 2016). Yet, in contrast to the literature on surgeons' learning curve when introducing new surgical methods and techniques (Palagonia et al, 2019), there is a paucity of research on learning curve at a team level. Although many factors affect the duration of an operation, interprofessional miscommunication is a significant predictor of deviation from expected length of operation (Gillespie et al, 2012).…”

Section: Discussionmentioning

confidence: 99%

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

Gillespie

Boorman

et al. 2020

Hum Factors

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Objective The aim of this study is to describe the impact of robotic-assisted surgery on team performance in the operating room. Background 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. Method 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. Results 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. Conclusion Inclusion of a robot as a team member adds further complexity to the work of surgery. Application These review findings will inform training programs specifically designed to optimize teamwork, workflow efficiency, and learning needs.

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“…As robotic technology is being rapidly implemented in different surgical specialties, with Urology in the forefront of this phenomenon [11], evidence supporting its use continues to build up ( Fig. 1), while ongoing debate related to increases costs [12] and need for structured training [13] remain.…”

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confidence: 99%