Effective and ineffective teamwork in robotic-assisted surgery: operating room professionals' accounts

Robotic-assisted surgery (RAS) has transformed modern surgical practice and introduced unique challenges to teamwork and communication. While prior research has examined human factors integration, barriers, and interventions in RAS, we explore operating room (OR) professionals' experiences of teamwork across all operative phases.

This study aims to give voice to OR professionals actively performing RAS and to understand what they perceive as effective and ineffective teamwork in their experiences.

Using an interpretivist paradigm, we conducted critical incident-based, semi-structured interviews with 21 OR professionals across multiple roles and specialties at two teaching hospitals using a closed-console RAS system. We analyzed the data using reflexive thematic analysis and employing an inductive, semantic coding strategy in which the content of the data was coded as explicitly described by the participants.

We organized the results across three operative phases. In the pre-operative phase, deliberate planning, including team briefings, equipment checks, procedural steps, and patient and robot positioning, was reported as more important for teamwork in RAS. During the intraoperative phase, effective and ineffective teamwork was, respectively, described as the presence or absence of explicit verbal communication (closed-loop communication, real-time narration, anticipation in tandem with verbal prompts), team reflexivity, centralized coordination through a bedside assistant, psychological safety, and shared mental models. In the post-operative phase, participants linked teamwork quality to patient safety and operative efficiency in a cascading effect.

Teamwork in RAS requires a more deliberate, structured team approach than in open or laparoscopic surgery. We provide best practices for effective teamwork and pitfalls to avoid in RAS. Targeted training emphasizing teamwork and communication may enhance team effectiveness and patient safety in robotic surgical environments.