Robotic nurse duties in the urology operative room: 11 years of experience

Roles, experience and views of nurses working in robotic surgery settings: A mixed-methods study

Robotic-assisted surgery has benefits for patients, but there are challenges to working in this field. In Turkey, training is not provided for nurses working in robotic-assisted surgery, and national legislation on nurses' roles in these settings has not been implemented. This study aimed to demonstrate the roles and experiences of nurses in robotic-assisted surgery in Turkey. This study was conducted as a mixed-methods research. The qualitative data were analysed by content analysis. More than half of the nurses had received basic training in robotic-assisted surgery. Qualitative data consisted of five themes, including the effects of robotic surgery, feelings and thoughts on robotic surgery, working as a nurse in robotic surgery settings, responsibilities of nurses and competence of nurses working in robotic surgery settings. Determining the working conditions and roles of nurses working in robotic-assisted surgery settings by policymakers in regulations is crucial for improving the quality of nursing care and the outcomes of patients.

How experienced robotic nurses adapt to the Hugo™ RAS system

No studies have reported on the impact at team level of the Medtronic Hugo™ RAS system. We described the work patterns and learning curves of an experienced robotic nurse team adapting to the new robotic system. We prospectively recorded the robotic nurse team's preoperative, perioperative, and postoperative tasks on the first 30 robotic procedures performed. The data were descriptively analyzed, and Gantt Charts were created for a timeline overview of the work patterns. We compared the operative times between the Medtronic Hugo™ RAS and the Davinci® system. The preoperative phase seemed to improve with a median time of 94 min (IQR 81-107). After 20 surgeries, the work pattern became more consistent where the scrub and circulating nurses worked simultaneously. There was no noticeable improvement for the perioperative and postoperative phases with a stable median time of 170 min (IQR 135-189) and 26 min (IQR 22-31). We found that the work pattern seemed to stabilize after 20 surgeries but with a continued decrease in preoperative time without a learning curve plateau. The robotic nurse team suffered from few breaks and long working hours because only a few nurses at our facility were trained in the Hugo™ system.

Human Factors Integration in Robotic Surgery

OBJECTIVE

Using the example of robotic-assisted surgery (RAS), we explore the methodological and practical challenges of technology integration in surgery, provide examples of evidence-based improvements, and discuss the importance of systems engineering and clinical human factors research and practice.

BACKGROUND

New operating room technologies offer potential benefits for patients and staff, yet also present challenges for physical, procedural, team, and organizational integration. Historically, RAS implementation has focused on establishing the technical skills of the surgeon on the console, and has not systematically addressed the new skills required for other team members, the use of the workspace, or the organizational changes.

RESULTS

Human factors studies of robotic surgery have demonstrated not just the effects of these hidden complexities on people, teams, processes, and proximal outcomes, but also have been able to analyze and explain in detail why they happen and offer methods to address them. We review studies on workload, communication, workflow, workspace, and coordination in robotic surgery, and then discuss the potential for improvement that these studies suggest within the wider healthcare system.

CONCLUSION

There is a growing need to understand and develop approaches to safety and quality improvement through human-systems integration at the frontline of care.Precis: The introduction of robotic surgery has exposed under-acknowledged complexities of introducing complex technology into operating rooms. We explore the methodological and practical challenges, provide examples of evidence-based improvements, and discuss the implications for systems engineering and clinical human factors research and practice.

Demands of surgical teams in robotic-assisted surgery: An assessment of intraoperative workload within different surgical specialties

BACKGROUND

Current approaches to assessing workload in robotic-assisted surgery (RAS) focus on surgeons and lack real-world data. Understanding how workload varies by role and specialty aids in identifying effective ways to optimize workload.

METHODS

SURG-TLX surveys with six domains of workload were administered to surgical staff at three sites. Staff reported workload perceptions for each domain on a 20-point Likert scale, and aggregate scores were determined per participant.

RESULTS

188 questionnaires were obtained across 90 RAS procedures. Significantly higher aggregate scores were reported for gynecology (Mdn ​= ​30.00) (p ​= ​0.034) and urology (Mdn ​= ​36.50) (p ​= ​0.006) than for general (Mdn ​= ​25.00). Surgeons reported significantly higher scores for task complexity (Mdn ​= ​8.00) than both technicians (Mdn ​= ​5.00) (p ​= ​0.007), and nurses (Mdn ​= ​5.00).

CONCLUSIONS

Staff reported significantly higher workload during urology and gynecology procedures, and experienced significant differences in domain workload by role and specialty, elucidating the need for tailored workload interventions.

Nurses' perceptions and experiences of robotic assisted surgery (RAS): An integrative review

AIM

To identify and review published literature on the perceptions and experience of nurses working with RAS.

BACKGROUND

Robotic assisted surgery (RAS) is rapidly becoming accepted as the elite modality for surgery since its introduction in the 1980 s, more recently there has been a rising trend of use with several specialities operating using this technology. The role of nurses in perioperative care has been described as maintaining the momentum of the patient's journey. Patients undergoing RAS require nursing care throughout their journey, therefore knowledge of nurses' experiences and perceptions of RAS is important to identifying nurse education and development needs.

DESIGN

Integrative literature review DATABASE SOURCES: Databases searched for peer reviewed studies included CINAHL, Academic Search Complete, EMBASE, Scopus, ADA Psycinfo, Medline.

REVIEW METHODS

A comprehensive database search was conducted following PRISMA guidelines. Six databases were searched with 523 screened for eligibility. Ten studies were included in the review seven qualitative and three quantitative.

RESULTS

Ten studies were identified, critically appraised and synthesised using thematic analysis. All studies were conducted with nurses in the perioperative environment. Key findings were that nurses education regarding RAS is limited with more emphasis placed on surgeon education and training. There was evidence that nurses experienced a lack of education, training and information as barriers to their role which subsequently raised their stress levels.

CONCLUSION

Evidence suggests a clear need for education and training for nurses working with RAS. In addition, nurses working with RAS provide care preoperatively, intraoperatively, postoperatively and post discharge in the community. However, no research has been conducted with nurses outside of the perioperative environment. Further research is required to understand the experiences and perceptions of nurses working with RAS patients in all care settings to identify their education and development needs.

ROBOTIC-ASSISTED VERSUS LAPAROSCOPIC INCISIONAL HERNIA REPAIR: DIFFERENCES IN DIRECT COSTS FROM A BRAZILIAN PUBLIC INSTITUTE PERSPECTIVE

BACKGROUND

Robotic-assisted surgery research has grown dramatically in the past two decades and the advantages over traditional videolaparoscopy have been extensively debated. For hernias, the robotic system can increase intraoperative strategies, especially in complex hernias or incisional hernias.

AIMS

This study aimed to compare the direct cost differences between robotic and laparoscopic hernia repair and determine each source of expenditure that may be related to the increased costs in a robotic program from the perspective of a Brazilian public institution.

METHODS

This study investigated the differences in direct costs from the data generated from a trial protocol (ReBEC: RBR-5s6mnrf). Patients with incisional hernia were randomly assigned to receive laparoscopic ventral incisional hernia repair (LVIHR) or robotic ventral incisional hernia repair (RVIHR). The direct medical costs of hernia treatment were described in the Brazilian currency (R$).

RESULTS

A total of 19 patients submitted to LVIHR were compared with 18 submitted to RVIHR. The amount spent on operation room time (RVIHR: 2,447.91±644.79; LVIHR: 1,989.67±763.00; p=0.030), inhaled medical gases in operating room (RVIHR: 270.57±211.51; LVIHR: 84.55±252.34; p=0.023), human resources in operating room (RVIHR: 3,164.43±894.97; LVIHR: 2,120.16±663.78; p<0.001), material resources (RVIHR: 3,204.32±351.55; LVIHR: 736.51±972.32; p<0.001), and medications (RVIHR: 823.40±175.47; LVIHR: 288.50±352.55; p<0.001) for RVIHR was higher than that for LVIHR, implying a higher total cost to RVIHR (RVIHR: 14,712.24±3,520.82; LVIHR: 10,295.95±3,453.59; p<0.001). No significant difference was noted in costs related to the hospital stay, human resources in intensive care unit and ward, diagnostic tests, and meshes.

CONCLUSION

Robotic system adds a significant overall cost to traditional laparoscopic hernia repair. The cost of the medical and robotic devices and longer operative times are the main factors driving the difference in costs.

Identifying curriculum content for operating room nurses involved in robotic-assisted surgery: a Delphi study

BACKGROUND

Currently, no generally accepted curriculum for operating room nurses (OR nurses) working with robotic-assisted surgery (RAS) exists. OR nurses working with RAS require different competencies than regular OR nurses, e.g. knowledge of the robotic system and equipment and specific emergency undocking procedures. The objective of this study was to identify learning goals for a curriculum for OR nurses working with RAS and to investigate which learning methods should be used.

METHODS

A three-round Delphi approach, with an additional survey, was used in this study. Four OR nurses from every department in gynecology, urology, and surgical gastroenterology doing RAS in Denmark were invited to participate.

RESULTS

The response rates were 93%, 81%, and 79%, respectively, in the three rounds of the Delphi survey and 68% in the additional survey. After the processing of data, a list of 57 learning goals, sorted under 11 domains, was produced. 41 learning goals were rated Relevant, Very relevant, or Essential spread over 10 of the 11 domains. The top 3 learning goals rated as Essential: Identify the most common injuries related to patient positioning during robotic-assisted surgery and know how to avoid them, Connect, calibrate and handle the scope, Perform an emergency undocking procedure. The panel rated Supervised training during surgery on patients as the most relevant learning method, followed by Dry lab and Team training.

CONCLUSIONS

The learning goals identified in this study, can be used as the basis for a curriculum for OR nurses working with RAS. During the processing, it became clear that there is a need to further investigate issues such as communication challenges, awareness of emergency procedures, and differences in the skills required depending on the role of the RAS nurse.

Understanding the role of the scrub nurse during robotic surgery

In the operating theatre, the scrub nurse has a wide range of roles, including responsibility for organising and ensuring that the correct instrumentation is available to the surgeon in the operating field, while maintaining stringent adherence to the principles of asepsis. Robotic techniques have revolutionised many procedures, providing surgeons with improved tissue access and tool control compared with open or laparoscopic techniques. However, adopting this technology has created additional challenges in the scrub nurse's role in areas such as team dynamics and the need to gather and disseminate vital patient information. This article explores the role of the scrub nurse and the challenges that may be encountered in the developing area of robotic surgery.

Pediatric robotic surgery: issues in management-expert consensus from the Italian Society of Pediatric and Neonatal Anesthesia and Intensive Care (SARNePI) and the Italian Society of Pediatric Surgery (SICP)

BACKGROUND

Pediatric robotic-assisted surgeries have increased in recent years; however, guidance documents are still lacking. This study aimed to develop evidence-based recommendations, or best practice statements when evidence is lacking or inadequate, to assist surgical teams internationally.

METHODS

A joint consensus taskforce of anesthesiologists and surgeons from the Italian Society of Pediatric and Neonatal Anesthesia and Intensive Care (SARNePI) and the Italian Society of Pediatric Surgery (SICP) have identified critical areas and reviewed the available evidence. The taskforce comprised 21 experts representing the fields of anesthesia (n = 11) and surgery (n = 10) from clinical centers performing pediatric robotic surgery in the Italian cities of Ancona, Bologna, Milan, Naples, Padua, Pavia, Perugia, Rome, Siena, and Verona. Between December 2020 and September 2021, three meetings, two Delphi rounds, and a final consensus conference took place.

RESULTS

During the first planning meeting, the panel agreed on the specific objectives, the definitions to apply, and precise methodology. The project was structured into three subtopics: (i) preoperative patient assessment and preparation; (ii) intraoperative management (surgical and anesthesiologic); and (iii) postoperative procedures. Within these phases, the panel agreed to address a total of 18 relevant areas, which spanned preoperative patient assessment and patient selection, anesthesiology, critical care medicine, respiratory care, prevention of postoperative nausea and vomiting, and pain management.

CONCLUSION

Collaboration among surgeons and anesthesiologists will be increasingly important for achieving safe and effective RAS procedures. These recommendations will provide a review for those who already have relevant experience and should be particularly useful for those starting a new program.

The role of the bedside assistant in robot-assisted surgery: A critical synthesis

INTRODUCTION

Robot-assisted surgery has grown exponentially since its inception and first approval in the United States in the year 2000. The surgeon operating with the assistance of the robot sits remotely to the patient and another practitioner assists at the bedside. The role of the bedside assistant and the training that is required to undertake this role are understudied topics.

AIM

To explore the functions, training and professional development of the bedside assistant in robot-assisted surgery and propose the necessary foundations for the safe enactment of the role in the United Kingdom.

METHODS

Through critical interpretative synthesis, relevant literature was systematically searched and analysed to inform integration of evidence.

RESULTS

Seventy-three studies were retrieved from the literature, across several health care disciplines and surgical specialities. These were critically analysed to inform a theoretically sound account grounded on evidence.

CONCLUSION

The role, functions and skills of the bedside assistant in robot-assisted surgery vary across contexts. These were analysed and critically synthetised to produce several keys to the success of bedside assistants in robot-assisted surgery in the context of the United Kingdom and of its national regulations.

Learning curves in laparoscopic and robot-assisted prostate surgery: a systematic search and review

PURPOSE

To perform a systematic search and review of the available literature on the learning curves (LCs) in laparoscopic and robot-assisted prostate surgery.

METHODS

Medline was systematically searched from 1946 to January 2021 to detect all studies in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement, reporting on the LC in laparoscopic radical prostatectomy (LRP), laparoscopic simple prostatectomy (LSP), robot-assisted radical prostatectomy (RARP) and robot-assisted simple prostatectomy (RSP).

RESULTS

In total, 47 studies were included for qualitative synthesis evaluating a single technique (LRP, RARP, LSP, RSP; 45 studies) or two techniques (LRP and RARP; 2 studies). All studies evaluated outcomes on real patients. RARP was the most widely investigated technique (30 studies), followed by LRP (17 studies), LSP (1 study), and RSP (1 study). In LRP, the reported LC based on operative time; estimated blood loss; length of hospital stay; positive surgical margin; biochemical recurrence; overall complication rate; and urinary continence rate ranged 40-250, 80-250, 58-200, 50-350, 110-350, 55-250, 70-350 cases, respectively. In RARP, the corresponding ranges were 16-300, 20-300, 25-200, 50-400, 40-100, 20-250, 30-200, while LC for potency rates was 80-90 cases.

CONCLUSIONS

The definition of LC for laparoscopic and robot-assisted prostate surgery is not well defined with various metrics used among studies. Nevertheless, LCs appear to be steep and continuous. Implementation of training programs/standardization of the techniques is necessary to improve outcomes.

A comparative study of the opinions, experiences and individual innovativeness characteristics of operating room nurses on robotic surgery

AIM

To compare and evaluate operating room nurses' opinions about robotic surgery with their individual innovativeness metric scores. The aim was also to identify the experiences, adaptation processes and influencing factors of operating room nurses working in robotic surgery rooms in Turkey.

DESIGN

This was a comparative descriptive study.

METHODS

The sample included 114 operating room nurses working in 12 institutions that performed robotic surgery in Turkey. Data were collected between January 2018 and September 2019 using the Demographic Characteristics of Nurses and Robotic Surgery Evaluation Form and the Individual Innovativeness Scale, and were analysed using a quantitative statistical approach (independent samples t-test, one-way analysis of variance and Kruskal-Wallis H test). The data obtained from the Robotic Surgery Evaluation section, which consisted of open-ended and closed-ended questions, were analysed with appropriate steps. In particular, answers to open-ended questions were grouped and coded according to their content.

RESULTS

Operating room nurses held positive opinions about robotic surgery. Only 35.8% of the nurses had received training before joining the robotic team, while 55.2% had individually searched for information. Operating room nurses with robotic surgery experience had significantly higher (p < .001) individual innovativeness scores. Over 85% of nurses who received training adapted to robotic surgery in 3 months or less, while nurses with higher individual innovativeness scores adapted in a statistically significantly (p < .05) shorter period. Training, teamwork, and practical experience were mentioned as facilitating factors; inadequate training and technical problems were reported as obstructing factors.

CONCLUSION

Operating room nurses hold positive opinions about robotic surgery; nurses with robotic surgery experience have higher levels of individual innovativeness; and nurses who have received training are significantly better adapted.

IMPACT

What problem did the study address? This study addresses the need for a better understanding of operating room nurses' opinions and experiences about robotic surgery and the influencing factors of adapting to it. This study also offers an evaluation and comparison of the nurses' individual innovativeness characteristics and the correlation with their adaptation processes to the new role. What were the main findings? The main findings show a correlation between specific education/training and nurses' adaptation to the new role of robotic surgery, the individual innovativeness characteristics metric of nurses with or without robotic surgery experience and the time frame of their adaptation. Where and on whom will the research have an impact? This research traces the profile of current operating room nurses working in the robotic surgery field and the factors influencing their experience. These findings and conclusions have a much broader impact than in Turkey alone. The findings raise awareness of the importance of educating and preparing operating room nurses before introducing them to the new roles and responsibilities inherent to robotic surgery.