Abstract
BackgroundRobotic surgery offers many potential benefits for patients. While an increasing number of healthcare providers are purchasing surgical robots, there are reports that the technology is failing to be introduced into routine practice. Additionally, in robotic surgery, the surgeon is physically separated from the patient and the rest of the team, with the potential to negatively impact teamwork in the operating theatre. The aim of this study is to ascertain: how and under what circumstances robotic surgery is effectively introduced into routine practice; and how and under what circumstances robotic surgery impacts teamwork, communication and decision making, and subsequent patient outcomes.Methods and designWe will undertake a process evaluation alongside a randomised controlled trial comparing laparoscopic and robotic surgery for the curative treatment of rectal cancer. Realist evaluation provides an overall framework for the study. The study will be in three phases. In Phase I, grey literature will be reviewed to identify stakeholders’ theories concerning how robotic surgery becomes embedded into surgical practice and its impacts. These theories will be refined and added to through interviews conducted across English hospitals that are using robotic surgery for rectal cancer resection with staff at different levels of the organisation, along with a review of documentation associated with the introduction of robotic surgery. In Phase II, a multi-site case study will be conducted across four English hospitals to test and refine the candidate theories. Data will be collected using multiple methods: the structured observation tool OTAS (Observational Teamwork Assessment for Surgery); video recordings of operations; ethnographic observation; and interviews. In Phase III, interviews will be conducted at the four case sites with staff representing a range of surgical disciplines, to assess the extent to which the results of Phase II are generalisable and to refine the resulting theories to reflect the experience of a broader range of surgical disciplines. The study will provide (i) guidance to healthcare organisations on factors likely to facilitate successful implementation and integration of robotic surgery, and (ii) guidance on how to ensure effective communication and teamwork when undertaking robotic surgery.
Highlights
Robotic surgery offers many potential benefits for patients
There is acknowledgement that there is a learning curve for the whole team [18], not just the surgeon, and that the whole team requires training [19]. Such recommendations come from small case series undertaken in single institutions, typically by dedicated robotic surgery enthusiasts [3], so that little is known about the contextual factors that are necessary for the successful integration of robotic surgery into healthcare organisations more broadly
The size of the robot introduces physical space constraints, resulting in a new choreography of movement around the patient [17]. The impact of this change in spatial configuration on communication and teamwork in the Operating theatre (OT) is not a topic that has been explored in evaluations of robotic surgery, which typically focus on the role of the surgeon [20]
Summary
Overall design We will undertake a realist process evaluation that will run alongside ROLARR (RObotic versus LAparoscopic Resection for Rectal Cancer), an international, multicentre prospective, randomised, controlled, unblended parallel-group trial, where the primary outcome is conversion to open surgery (as an indicator of technical difficulty) [29]. In Phase I, the first ‘theory elicitation’ stage of a realist synthesis will be undertaken to catalogue stakeholders’ theories concerning how robotic surgery becomes embedded into surgical practice and its impacts. The overall approach to analysis will involve initial comparisons in the processes and outcomes of interest (i.e., those specified in the CMO configurations) between laparoscopic and robotic surgery, before using the data from the robotic surgery operations to test the CMO configurations. Ethnographic field notes and interview transcripts Field notes and interview transcripts will be entered into NVivo 10 for indexing and will be analysed using the methods outlined for the analysis of the interview data in Phase I This will identify data to support or refute particular CMO configurations, as well as identifying additional CMO configurations. NHS Research Ethics Committee approval for Phases II and III of the study has been granted (13/YH/0153)
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
