A Discrete-Event Simulation Model to Configure Operating Rooms for Robotic Cardiac Surgery

Background. Robotic cardiac surgery (RCS) has emerged as a promising alternative in clinical practice to overcome the limitations of minimally invasive techniques. However, the integration of RCS with surgical process management is key in taking full advantage of its benefits. Aim. We assess the performance of RCS interventions as a function of operating room (OR) layout, using a discrete-event simulation (DES) tool, which allows the simulation of different RCS procedures in different layouts. Methods. A DES model was developed for 2 types of RCS, atrial fibrillation ablation and mitral valve repair, to analyze them in the presence of different OR layouts. Data on the activities and timings of all operators in the OR, used to feed the DES, were collected on site at Humanitas Gavazzeni Hospital, Bergamo, Italy, through direct recording during RCS procedures. Results. The advantages and disadvantages of different OR layouts were highlighted and quantified through a series of key performance indicators and qualitative outcomes, including the overall duration of the entire surgical process, the distance covered by the surgical team, and their utilization. Specifically, the characteristics of a new, larger OR in the considered hospital were assessed prior to the actual transfer of the RCS department in the new OR. Conclusion. This work provided valuable insights and recommendations to RCS operators, which were put in practice, specifically tailoring OR configurations to RCS procedural characteristics.

Discrete event simulation (DES) is used for the first time to improve the performance of robotic cardiac surgery (RCS), an application that presents unique challenges.The flexible DES model for RCS can parametrize various factors related to both operating rooms and procedures.The impact of these factors is evaluated on a set of KPIs.New insights into the positioning of equipment and personnel in the OR are provided, allowing to formulate informed recommendations for RCS providers.