Recommendations for Emergency Robotic Thoracic Conversions and Intraoperative Resuscitation: A Modified Delphi...

Area of Science:

• Thoracic Surgery
• Robotic Surgery
• Surgical Safety

Background:

• Emergency conversion events in robotic thoracic surgery present unique challenges.
• Standardized principles are needed to manage these critical situations effectively.

Purpose of the Study:

• To determine essential principles and acceptable variations for emergency conversion events in robotic thoracic surgery.
• To develop consensus-based guidelines for managing intraoperative emergencies.

Main Methods:

• A modified Delphi study involving 21 expert robotic thoracic surgeons.
• Two rounds of statement rating using a 5-point Likert scale (≥70% agreement for consensus).
• Inclusion of preoperative preparation, emergency undocking/resuscitation, and debriefing domains.

Main Results:

• 100% response rate achieved.
• Consensus reached on all preoperative preparation and debriefing statements.
• 16 out of 19 undocking/resuscitation statements achieved consensus; 3 showed insufficient agreement (66.7%).
• Key consensus principles included conversion indications, calling for help, robotic tamponade, partial undocking, visualization, and team communication.

Conclusions:

• The achieved consensus provides a foundation for developing protocols for emergency robotic thoracic surgery conversions.
• Areas of disagreement highlight surgeon- and institution-specific variations that may be acceptable.