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Emergency Undocking in Robotic Surgery: A Simulation Curriculum

Emergency Undocking in Robotic Surgery: A Simulation Curriculum

Published on: May 20, 2018

Use of In-Situ Simulation Based Clinical Systems Test of Thoracic Robotic Surgery Emergencies.

Bryce M Bludevich¹, Hannah Buettner¹, Max Hazeltine¹

¹Division of Thoracic Surgery, UMASS T.H. Chan School of Medicine, Worcester, Massachusetts.

The Journal of Surgical Research

|March 25, 2022

Summary

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Simulation-based clinical systems testing (SbCST) effectively identifies safety threats in robotic thoracic surgery. This practice improves operating room team confidence and preparedness for rare emergencies, enhancing patient safety.

Area of Science:

Robotic Surgery
Medical Simulation
Patient Safety

Background:

Thoracic surgeons are hesitant to adopt robotic surgery due to concerns about intra-operative emergencies while un-scrubbed.
In-situ simulation-based clinical systems testing (SbCST) offers a solution to practice rare, high-stakes scenarios and test clinical systems.

Purpose of the Study:

To evaluate the effectiveness of SbCST in identifying latent safety threats (LSTs) during robot-assisted thoracic surgery.
To assess the impact of SbCST on operating room (OR) team confidence and preparedness for intra-operative emergencies.

Main Methods:

Six OR teams participated in an in-situ SbCST of a simulated pulmonary artery injury during robot-assisted thoracic surgery.
Latent safety threats (LSTs) were identified, and a Failure Mode and Effects Analysis (FMEA) was conducted, including Risk Priority Number (RPN) calculation.

Keywords:

Intra-operative emergencies Robotic surgery Simulation training Systems test Thoracic surgery

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Pre- and post-simulation surveys assessed team confidence and the perceived value of simulation.

Main Results:

Twenty-eight LSTs were identified across six FMEAs, with nine deemed high priority (RPN).
Ninety-four percent of participants found high-fidelity simulation helpful for training in rare, high-stakes events.
Post-simulation, participants reported increased confidence in their roles and in safely undocking the robot during emergencies.

Conclusions:

SbCST effectively tests clinical systems and allows OR teams to practice skills and teamwork for rare, high-stakes events.
Integrating SbCST with debriefing and FMEA enhances system improvements and patient safety.
SbCST is a valuable tool for identifying and mitigating risks in robotic thoracic surgery.