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Barriers to efficiency in robotic surgery: the resident effect.

Monica Jain1, Brian T Fry2, Luke W Hess3

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Analyzing robotic surgery flow disruptions (FDs) revealed that while resident training FDs are frequent, equipment and external factors may impact operative duration more significantly. Performance improvement efforts should target these impactful FDs for better efficiency.

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Area of Science:

  • Surgical Innovation
  • Medical Technology Assessment
  • Healthcare Operations Management

Background:

  • Robotic surgery presents advantages over traditional methods but incurs higher costs and risks.
  • Surgical flow disruptions (FDs), defined as deviations from the natural operative progression, offer insights into improving robotic procedures.
  • Analyzing FDs can help refine training protocols and identify areas for enhanced surgical efficiency.

Purpose of the Study:

  • To analyze the frequency and impact of surgical flow disruptions (FDs) in robotic surgery.
  • To determine factors influencing FDs, including procedure type, robot model, and resident involvement.
  • To identify specific types of FDs that most significantly affect operative duration.

Main Methods:

  • Observation of 32 robotic surgery operations over a 6-week period.
  • Detailed recording and classification of FDs into 11 categories.
  • Linear regression analysis to assess the impact of FDs and influencing factors on operative duration.

Main Results:

  • A mean of 48.2 FDs per operation was observed, with each FD adding an average of 2.4 minutes to operative duration.
  • Resident involvement significantly affected the number and rate of FDs.
  • FDs differed between resident and non-resident cases, with training/equipment FDs common in residents and equipment/external factors in non-residents.

Conclusions:

  • While training-related FDs in residents are frequent, they may not substantially increase operative time.
  • Equipment malfunctions and external factors represent more impactful FDs requiring targeted improvement strategies.
  • Focusing performance improvement efforts on limiting equipment and external factor FDs is recommended to enhance robotic surgery efficiency.