Work-system interventions in robotic-assisted surgery: a systematic review exploring the gap between challenges and solutions

Surg Endosc. 2021 May;35(5):1976-1989. doi: 10.1007/s00464-020-08231-x. Epub 2021 Jan 4.


Background: The introduction of a robot into the surgical suite changes the dynamics of the work-system, creating new opportunities for both success and failure. An extensive amount of research has identified a range of barriers to safety and efficiency in Robotic Assisted Surgery (RAS), such as communication breakdowns, coordination failures, equipment issues, and technological malfunctions. However, there exists very few solutions to these barriers. The purpose of this review was to identify the gap between identified RAS work-system barriers and interventions developed to address those barriers.

Methods: A search from three databases (PubMed, Web of Science, and Ovid Medline) was conducted for literature discussing system-level interventions for RAS that were published between January 1, 1985 to March 17, 2020. Articles describing interventions for systems-level issues that did not involve technical skills in RAS were eligible for inclusion.

Results: A total of 30 articles were included in the review. Only seven articles (23.33%) implemented and evaluated interventions, while the remaining 23 articles (76.67%) provided suggested interventions for issues in RAS. Major barriers identified included disruptions, ergonomic issues, safety and efficiency, communication, and non-technical skills. Common solutions involved team training, checklist development, and workspace redesign.

Conclusion: The review identified a significant gap between issues and solutions in RAS. While it is important to continue identifying how the complexities of RAS affect operating room (OR) and team dynamics, future work will need to address existing issues with interventions that have been tested and evaluated. In particular, improving RAS-associated non-technical skills, task management, and technology management may lead to improved OR dynamics associated with greater efficiency, reduced costs, and better systems-level outcomes.

Keywords: Checklists; Communication; Human factors; Simulation; Team training.

Publication types

  • Research Support, U.S. Gov't, P.H.S.
  • Systematic Review

MeSH terms

  • Checklist
  • Communication
  • Efficiency
  • Ergonomics
  • Humans
  • Operating Rooms / organization & administration*
  • Robotic Surgical Procedures / methods*
  • Surgeons