Challenges With Robot-Assisted Surgery Setup for Complex Minimally Invasive Upper Gastrointestinal Surgery

Area of Science:

• Minimally Invasive Surgery
• Surgical Technology
• Human Factors Engineering

Background:

• Robot-assisted surgery (RAS) utilization has surged, introducing new complexities in operating room workflows.
• Effective management of these complexities is crucial for successful surgical outcomes.
• This study addresses challenges in the setup phase of complex upper gastrointestinal RAS (UGI-RAS).

Purpose of the Study:

• To analyze setup challenges in complex UGI-RAS.
• To identify opportunities for workflow optimization and solution implementation.

Main Methods:

• Direct observations of UGI-RAS setup processes by a Human Factors researcher.
• Documentation of setup phases, task timings, and workflow disruptions (FDs).
• Descriptive statistical analysis of setup tasks and identified FDs.

Main Results:

• Twenty UGI-RAS setup procedures were observed, including sleeve gastrectomy and para-esophageal hernia repair.
• Frequent workflow disruptions involved planning breakdowns (29.85%) and equipment/supply management (25.37%).
• Delayed starts were common in first-start cases (10 out of 11 observed).

Conclusions:

• Pre-operative team huddles and targeted training can mitigate UGI-RAS setup challenges.
• Interventions can enhance teamwork, efficiency, and communication.
• Solutions aim to reduce case start delays and improve overall turnover time.