The Loud Surgeon Behind the Console: Understanding Team Activities During Robot-Assisted Surgery

Judith Tiferes; Ahmed A Hussein; Ann Bisantz; Justen D Kozlowski; Mohamed A Sharif; Nathalie M Winder; Nabeeha Ahmad; Jenna Allers; Lora Cavuoto; Khurshid A Guru

doi:10.1016/j.jsurg.2015.12.009

The Loud Surgeon Behind the Console: Understanding Team Activities During Robot-Assisted Surgery

J Surg Educ. 2016 May-Jun;73(3):504-12. doi: 10.1016/j.jsurg.2015.12.009.

Authors

Affiliations

¹ Department of Industrial and Systems Engineering, University at Buffalo, The State University of New York, Buffalo, New York; Advanced Technology Laboratory for Applied Surgery (A.T.L.A.S), Department of Urology, Roswell Park Cancer Institute, Buffalo, New York.
² Advanced Technology Laboratory for Applied Surgery (A.T.L.A.S), Department of Urology, Roswell Park Cancer Institute, Buffalo, New York; Department of Urology, Cairo University, Cairo, Egypt.
³ Department of Industrial and Systems Engineering, University at Buffalo, The State University of New York, Buffalo, New York.
⁴ Advanced Technology Laboratory for Applied Surgery (A.T.L.A.S), Department of Urology, Roswell Park Cancer Institute, Buffalo, New York.
⁵ Advanced Technology Laboratory for Applied Surgery (A.T.L.A.S), Department of Urology, Roswell Park Cancer Institute, Buffalo, New York. Electronic address: Khurshid.guru@roswellpark.org.

PMID: 27068189
DOI: 10.1016/j.jsurg.2015.12.009

Abstract

Objectives: To design a data collection methodology to capture team activities during robot-assisted surgery (RAS) (team communications, surgical flow, and procedural interruptions), and use relevant disciplines of Industrial Engineering and Human Factors Engineering to uncover key issues impeding surgical flow and guide evidence-based strategic changes to enhance surgical performance and improve outcomes.

Design: Field study, to determine the feasibility of the proposed methodology.

Setting: Recording the operating room (OR) environment during robot-assisted surgeries (RAS). The data collection system included recordings from the console and 3 aerial cameras, in addition to 8 lapel microphones (1 for each OR team member). Questionnaires on team familiarity and cognitive load were collected.

Participants: In all, 37 patients and 89 OR staff members have consented to participate in the study.

Results: Overall, 37 RAS procedures were recorded (130 console hours). A pilot procedure was evaluated in detail. We were able to characterize team communications in terms of flow, mode, topic, and form. Surgical flow was evaluated in terms of duration, location, personnel involved, purpose, and if movements were avoidable or not. Procedural interruptions were characterized according to their duration, cause, mode of communication, and personnel involved.

Conclusion: This methodology allowed for the capture of a wide variety of team activities during RAS that would serve as a solid platform to improve nontechnical aspects of RAS.

Keywords: Interpersonal and Communication Skills; Practice-Based Learning and Improvement; Systems-Based Practice; communication; flow; interruptions; nontechnical skills; robot-assisted surgery; team interactions.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Communication
Data Collection
Efficiency
Environment
Ergonomics
Feasibility Studies
Humans
Operating Rooms*
Patient Care Team*
Quality Improvement
Robotic Surgical Procedures*
Surveys and Questionnaires
Task Performance and Analysis*