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Robot set-up time in urologic surgery: an opportunity for quality improvement

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Abstract

Introduction

Robotic-assisted techniques are widespread in urology. However, prolonged preparation time for robotic cases hinders operating room (OR) efficiency and frustrates robotic surgeons. Pre-operative times are an opportunity for quality improvement (QI) and enhancing OR throughput. We have previously shown that pre-operative times in robotic cases are highly variable and that increasing patient complexity was associated with longer times. Our objective was to characterize set-up times in robotic urology cases and to determine whether prolongation was due to robot set-up, in particular.

Materials and methods

Patients undergoing robotic-assisted urology procedures at our academic institution had routine peri-operative collection of demographic data and OR time stamps. Following IRB approval, we retrospectively reviewed set-up times from an OR database. Multivariable analysis was used to assess the influence of independent patient variables—gender (M/F), smoking history, age, BMI, American Society of Anesthesiologists (ASA) Physical Status Classification, and Charlson Comorbidity Index (CCI)—on robot set-up times. Institutional factors including procedure, surgeon, and case year were also assessed.

Results

A total of 808 patients undergoing 816 robotic-assisted procedures from 2013 to 2018 met inclusion criteria. Robot set-up times varied only by gender (F > M) but not by general patient complexity. Age, BMI, smoking status, ASA, and CCI did not play a role in prolonging robot set-up times. There was marked variability of robot set-up times, even within procedure type. Robot set-up times generally improved over time for a given surgeon.

Conclusions

Robot set-up time is not affected by patient complexity, in contrast to pre-operative time. It is affected by procedure type and does improve with experience. There is wide variability of robot set-up times and this is an important target for surgical QI.

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Funding

There were no extra-institutional sources of funding.

Author information

Correspondence to David J. Kozminski.

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Conflict of interest

There are no reported conflicts of interest for any author. David Kozminski, Matthieu Cerf, Paul Feustel, and Barry Kogan each declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Kozminski, D.J., Cerf, M.J., Feustel, P.J. et al. Robot set-up time in urologic surgery: an opportunity for quality improvement. J Robotic Surg (2020). https://doi.org/10.1007/s11701-020-01049-8

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Keywords

  • Robotic-assisted surgery
  • Robot set-up
  • Quality improvement
  • Operating room
  • Efficiency