Ambulatory movements, team dynamics and interactions during robot-assisted surgery

Area of Science:

• Surgical Technology
• Human Factors Engineering
• Operating Room Management

Background:

• Robot-assisted surgery (RAS) offers numerous benefits but introduces complex equipment into the operating room (OR).
• The physical configuration of the OR and the resulting team dynamics during RAS are not fully understood.
• Potential for workflow challenges and adverse events due to space congestion in RAS needs investigation.

Purpose of the Study:

• To analyze ambulatory movements and team dynamics during robot-assisted surgery (RAS).
• To determine if physical space congestion during RAS leads to workflow challenges or predisposes to errors.
• To identify opportunities for optimizing the OR environment for RAS.

Main Methods:

• Retrospective review of 10 robot-assisted radical prostatectomies.
• Division of the OR into eight zones for movement tracking.
• Classification of ambulatory movements into avoidable and unavoidable categories.

Main Results:

• Ambulatory movements accounted for 16% of the mean 166-minute operating time.
• A total of 2,896 ambulatory movements were recorded, with 50% identified as avoidable.
• The circulating nurse performed most movements, with heavy traffic observed between specific OR zones.

Conclusions:

• More than half of the ambulatory movements during RAS are avoidable.
• Improving the OR setting can significantly enhance efficiency and safety.
• Evidence-based OR design is crucial for optimizing workflow and patient safety in RAS.