High-intensity theatre lists for robot-assisted thoracic resection: a proof-of-concept series

Area of Science:

• Thoracic Surgery
• Surgical Workflow Optimization
• Robotic Surgery

Background:

• The high-intensity theatre (HIT) list model enhances surgical efficiency by minimizing downtime between procedures.
• Its application to major anatomical thoracic resections, particularly robot-assisted procedures, has not been previously documented.
• Optimizing theatre throughput is crucial for managing surgical backlogs and improving patient access.

Purpose of the Study:

• To evaluate the feasibility and safety of implementing a HIT list model for robot-assisted anatomical thoracic resections.
• To assess the impact of the HIT model on surgical throughput, turnaround times, and patient outcomes.
• To determine if this model can increase the number of major thoracic resections performed without additional resources.

Main Methods:

• A prospective service evaluation of two HIT lists involving 15 consecutive patients undergoing robot-assisted anatomical lung resection.
• Utilized the da Vinci Xi platform with a pre-defined workflow, including pre-positioning patients in the anaesthetic room.
• Collected data on list completion, console time, turnaround time, complications (Clavien-Dindo), length of stay, and mortality.

Main Results:

• Achieved 100% list completion, performing ten major resections in 5 hours 45 minutes in one list.
• Demonstrated minimal inter-case turnaround times of 2-3 minutes.
• Reported no increase in safety concerns, with nil 30- and 90-day mortality, though 33% of patients experienced complications.

Conclusions:

• The HIT list model is a feasible approach for major anatomical thoracic resections, significantly increasing theatre throughput.
• This model can be safely implemented for robot-assisted thoracic surgery, showing promise for improving efficiency.
• Further prospective multicentre evaluation is recommended before widespread adoption of this surgical workflow.