Robotic Assisted Surgery: The Gap Between Challenges And Solutions

Abstract

A roboticist by the name of Rodney Brooks once said, “the benefits of having robots could vastly outweigh the problems.” While this may be true, it is important to assess these problems and understand how they may be mitigated. The use of robots is growing in many industries and can be found in areas such as manufacturing, healthcare, agriculture, food preparation and national defense. Within healthcare, robots are commonly used in surgery to perform procedures such as sacrocolpopexies, prostatectomies, hysterectomies, hernia repairs and nephrectomies. The benefits of robotic-assisted surgery (RAS) are similar to laparoscopy and include decreased blood loss, faster recovery time, and shorter lengths of stay at the hospital. Unlike purely laparoscopic surgery, the robot provides wrist dexterity, allowing for more complex surgeries to be performed in a minimally invasive fashion by surgeons who may not have expertise in laparoscopy. However, recent reports have heightened challenges facing RAS operating room (OR) teams. Effects of the OR layout, team communication, team coordination, disruptions to workflow, and equipment malfunctions were among the issues observed in a variety of RAS procedures. Issues such as disruptions to the workflow trigger delays and inefficiencies, which in turn could affect patient safety and quality of care. As part of a wider study to implement and evaluate multiple interventions associated with improving efficiency and safety of RAS, a literature search was conducted to investigate issues experienced by the OR team in RAS and the interventions developed and tested to resolve these issues. The literature search excluded studies concerned with laparoscopic and open surgery; proficiency training; and articles that were not written in English. Commentaries, editorials, and abstracts were further excluded. At the conclusion of the literature search, 17 articles involving the implementation or evaluation of interventions surrounding RAS were evaluated and categorized based on the issues that were addressed. Seven articles discussed disruptions to the OR team’s workflow; five articles discussed issues with patient safety, surgical complications, or risk assessment; three papers discussed issues with teamwork; and the remaining articles discussed issues with communication, efficiency, cognitive load, and surgical performance. Despite the number of articles that were found to discuss issues in RAS, only four of the 17 articles implemented interventions. The interventions primarily included the use of checklists and nontechnical skills training. The scarce number of articles focusing on interventions aimed at improving the safety, quality, and efficiency of RAS demonstrates the wide gap that exists between known problems and potential solutions. As the number of robotic-assisted procedures continue to grow, it is important to improve OR team efficiency and patient care. The current study is part of a five-year, four-site study investigating the nature of issues that exist in RAS. The larger study will also design and implement interventions based on RAS observations conducted by the researchers in an effort to ensure that the benefits of robotic surgery truly do outweigh the existing problems.