Operating room communication in robotic surgery: Place, modalities and evolution of a safe system of interaction

The aim of this study was to evaluate by questionnaire the feelings and the expectations of the different members of the operating room (OR) team in terms of communication during a robotic surgery with remote operator immersion.

A total of 130 questionnaires were sent to several surgical units equipped for robotic surgery and addressed to operators (O), operative assistants (OA) and scrub nurses (SN). It included 32 questions addressing the following themes: function, experience, previous training, impressions about communication (difficulties, the place of verbal interactions, evolution with experience and role of each team member in communication).

Only 17.4% of responses reported the use of communication protocols. The need for systematic description by the OA/SN of the difficulties in performing an action outside the operator's visual field was perceived as "essential" by 59%, 44.4% and 73.7%, "useful" by 35.9%, 55.6% and 21.1% of the SN, OA and O, respectively. Impaired communication was experienced during the learning phase by 60%, 80% and 57.9% of the SN, OA and O, respectively. During the apprenticeship phase, >92% of the OR team members felt that a systematic mode of verbal control was particularly useful. With the acquisition of experience, 82.1%, 80% and 73.7% of the SN, OA and O, respectively, thought it was necessary to continue a systematic mode of communication.

With immersion, the surgeon unconsciously loses non-verbal exchange and becomes cut off from his surgical environment. The assistant is the one who perceives feelings of isolation most acutely. Therefore, interaction and communication must be verbal, systematic and safe. Systematic verbal communication should be reinforced during the training phase and continued thereafter although it could become more relaxed as experience increases.