Impaired robotic surgical visualization: archaic issues in a modern operating room

Area of Science:

• Surgical Technology
• Medical Visualization
• Robotics in Medicine

Background:

• Robotic-assisted surgery (RAS) offers advancements but faces visualization challenges.
• Lens occlusions, common in laparoscopy, are understudied in RAS.
• Suboptimal vision can disrupt surgical procedures.

Purpose of the Study:

• To quantify the impact of poor visualization due to lens occlusions in RAS.
• To identify causes and patterns of visual disruption during robotic surgery.
• To assess the frequency and duration of lens cleaning events.

Main Methods:

• Observation of 28 robotic-assisted surgery procedures across various specialties.
• Recording of lens occlusion events, clinician reactions, causes, and monitor location.
• Analysis of approximately 44.33 hours of surgical observation time.

Main Results:

• 163 debris events recorded, with 52.53% of observation time under compromised visualization.
• Cautery identified as the primary cause of lens occlusions.
• Lens cleaning occupied 2.24% of observation time in a subset of cases, interrupting workflow.

Conclusions:

• Poor robotic visualization is a significant issue, affecting a majority of surgical time.
• Lens occlusions, primarily from cautery, frequently disrupt RAS procedures.
• Interventions to improve robotic visualization are needed to optimize surgical efficiency.