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Non-technical skills in robotic surgery and impact on near-miss events: a multi-center study

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Abstract

Background

Robotic surgery requires a set of non-technical skills (NTS), because of the complex environment. We aim to study relationship between NTS and near-miss events in robotic surgery.

Methods

This is an observational study in five French centers. Three robotic procedures were observed and filmed by one of expert trainers in NTS. They established and scored a non-technical skills in robotic surgery (NTSRS) score, that included eight items, each scored from 1 to 5, to assess the whole surgical teams. The surgical teams also self-assessed their work. The number of near-miss events was recorded and classified as minor, or major but no harm incidents, independently by two surgeons. Correlations were Spearman coefficients.

Results

Of the 26 procedures included, 15 were prostatectomy (58%), 9 nephrectomy (35%), and 2 pyeloplasty (7.7%). Half of procedures (n = 13) were performed by surgeons with extensive RS experience (more than 150 procedures). Per procedure, there was a median (quartiles) of 9 (7; 11) near-miss events. There was 1 (0; 2) major near-miss events, with no harm. The median NTSRS score was 18 (14; 21), out of 40. The number of near-miss events was strongly correlated with the NTSRS score (r = − 0.92, p < 0.001) but was not correlated with the surgeon’s experience. The surgeons for fifteen (58%) procedures, and the bed-side surgeons for 11 (42%) procedures, felt that there was no need for an improvement in the quality of their NTS. None of the surgeons gave a negative self-evaluation for any procedure; in three procedures (12%), the bed-side surgeons self-assessed negatively, on ergonomics.

Conclusion

Occurrence of near-miss events was reduced in teams managing NTS. Specific NTS surgical team training is essential for robotic surgery as it may have a significant impact on risk management.

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Acknowledgements

The authors would like to thank Drs. Jean Baptiste Beauval, Nicolas Doumerc for their contributions to the study. The authors acknowledge Mr. Alexandre Thouroude, Mrs. Marjorie Mazeau, Mr. Erwan de Penfentenyo de Kervereguen and Mr. Jean-Pierre Henry from Stan Institute for their precious help and their enlightened vision and open-mindedness. A special acknowledgement for Dr. Beverley Balkau for her external writing review. Anthony Manuguerra acknowledges the support from Surgery school of Medicine Faculty of Nancy and Stan Institute and the help of the Toulouse University Hospital, Nancy University Hospital, Gentilly polyclinic in Nancy, Montpellier University Hospital, and Robert Schuman Hospital in Metz.

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Authors and Affiliations

  1. Department of Urology, CHRU Nancy Brabois University Hospital, 5 Rue du Morvan, 54500, Vandoeuvre-Lès-Nancy, France

    Anthony Manuguerra, Charles Mazeaud, Pascal Eschwège & Jacques Hubert

  2. Department of Surgery, Institut de Cancérologie de Lorraine, Université de Lorraine, 54519, Vandoeuvre-Lès-Nancy, France

    Anthony Manuguerra & Pascal Eschwège

  3. Department of Urology, Gentilly Polyclinic, Nancy, France

    Nicolas Hubert

  4. Unité de Biologie Des Tumeurs CNRS-CRAN UMR 7039, Vandoeuvre-Lès-Nancy, France

    Pascal Eschwège

  5. Department of Urology, Toulouse Rangueuil University Hospital, Toulouse, France

    Mathieu Roumiguié

  6. Department of Biostatistics, Institut de Cancérologie de Lorraine, Université de Lorraine, 54519, Vandoeuvre-Lès- Nancy, France

    Julia Salleron

  7. IADI-UL-INSERM (U1254), University Hospital, Nancy, France

    Jacques Hubert

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  1. Anthony Manuguerra
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Correspondence to Anthony Manuguerra.

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Drs Anthony Manuguerra, Nicolas Hubert, Charles Mazeaud, Mathieu Roumiguie, Prof. Pascal Eschwege and Jacques Hubert, Miss Julia Salleron report that they have no conflicts of interest or financial ties to disclose.

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All members of surgical teams gave their consent to be filmed and assessed during procedures.

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Non-technical skills are known to be essential in surgery. We aimed to study their impact on risk management in robotic surgery, due to its specific spatial configuration by assessing non-technical skills of surgical teams and occurrence of near-miss events.

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Manuguerra, A., Mazeaud, C., Hubert, N. et al. Non-technical skills in robotic surgery and impact on near-miss events: a multi-center study. Surg Endosc 35, 5062–5071 (2021). https://doi.org/10.1007/s00464-020-07988-5

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