Background: The purpose of this consensus was to determine essential principles and acceptable variations in emergency conversion events in robotic thoracic operations.
Methods: A modified Delphi study was performed with 21 expert robotic thoracic surgeons. A pilot round was conducted with 5 experts to test feasibility. Two rounds were conducted between July 2024 and September 2024 with 33 statements rated on 5-point Likert scales. Statements included content across 3 domains: (1) preoperative preparation, (2) emergency undocking and resuscitation in the lateral position, and (3) debriefing. A consensus report was provided to panelists after round 1, and a focus group was held. Content was adjusted between rounds based on feedback from round 1 and the focus group. Consensus was defined as agreement ≥70%.
Results: The response rate was 100%. Consensus was achieved for all preoperative preparation and debriefing statements. Of 19 statements regarding undocking and resuscitation, 16 achieved consensus, and 3 statements (9.1%) in this domain were found to have insufficient agreement at 66.7%. Essential principles that achieved consensus included conversion indications, calling for help, initial tamponade with robotic instruments, conversion using a partial undocking protocol, uninterrupted visualization, and team communication, among others.
Conclusions: The consensus achieved can inform protocols for emergency robotic conversion events in thoracic surgery. The points of disagreement highlight acceptable surgeon- and institution-specific variations.
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