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Barriers to safety and efficiency in robotic surgery docking

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Abstract

Background

The introduction of new technology into the operating room (OR) can be beneficial for patients, but can also create new problems and complexities for physicians and staff. The observation of flow disruptions (FDs)—small deviations from the optimal course of care—can be used to understand how systems problems manifest. Prior studies showed that the docking process in robotic assisted surgery (RAS), which requires careful management of process, people, technology and working environment, might be a particularly challenging part of the operation. We sought to explore variation across multiple clinical sites and procedures; and to examine the sources of those disruptions.

Methods

Trained observers recorded FDs during 45 procedures across multiple specialties at three different hospitals. The rate of FDs was compared across surgical phases, sites, and types of procedure. A work-system flow of the RAS docking procedure was used to determine which steps were most disrupted.

Results

The docking process was significantly more disrupted than other procedural phases, with no effect of hospital site, and a potential interaction with procedure type. Particular challenges were encountered in room organization, retrieval of supplies, positioning the patient, and maneuvering the robot.

Conclusions

Direct observation of surgical procedures can help to identify approaches to improve the design of technology and procedures, the training of staff, and configuration of the OR environment, with the eventual goal of improving safety, efficiency and teamwork in high technology surgery.

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Funding

This project was funded under Grant Number HS026491-01 from the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services (KC, JA, TC). The authors are solely responsible for this document’s contents, findings, and conclusions, which do not necessarily represent the views of AHRQ. Readers should not interpret any statement in this report as an official position of AHRQ or of HHS. None of the authors has any affiliation or financial involvement that conflicts with the material presented in this report.

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Authors and Affiliations

  1. Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC, USA

    Lucy Cofran, Myrtede Alfred & Ken Catchpole

  2. Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Tara Cohen, Falisha Kanji & Eunice Choi

  3. Department of Urology, Medical University of South Carolina, Charleston, SC, USA

    Stephen Savage

  4. Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Jennifer Anger

  5. Medical University of South Carolina, Storm Eye Building, 167 Ashley Avenue, Charleston, SC, 29425, USA

    Ken Catchpole

Authors
  1. Lucy Cofran
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  2. Tara Cohen
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  3. Myrtede Alfred
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  4. Falisha Kanji
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  5. Eunice Choi
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  7. Jennifer Anger
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  8. Ken Catchpole
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Corresponding author

Correspondence to Ken Catchpole.

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Disclosures

Jennifer Anger is on the advisory board for Axonics. Lucy Cofran, Tara Cohen, Myrtede Alfred, Falisha Kanji, Eunice Choi, Stephen Savage, and Ken Catchpole have no conflicts of interest or financial ties to disclose.

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Cofran, L., Cohen, T., Alfred, M. et al. Barriers to safety and efficiency in robotic surgery docking. Surg Endosc 36, 206–215 (2022). https://doi.org/10.1007/s00464-020-08258-0

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  • DOI: https://doi.org/10.1007/s00464-020-08258-0

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