Barriers to safety and efficiency in robotic surgery docking.

Background The introduction of new technology into the operating room (OR) can be beneficial for patients, but can also create new problems and complexities for physicians and staff. The observation of flow disruptions (FDs)—small deviations from the optimal course of care—can be used to understand how systems problems manifest. Prior studies showed that the docking process in robotic assisted surgery (RAS), which requires careful management of process, people, technology and working environment, might be a particularly challenging part of the operation. We sought to explore variation across multiple clinical sites and procedures; and to examine the sources of those disruptions.

Trained observers recorded FDs during 45 procedures across multiple specialties at three different hospitals. The rate of FDs was compared across surgical phases, sites, and types of procedure. A work-system flow of the RAS docking procedure was used to determine which steps were most disrupted.

The docking process was significantly more disrupted than other procedural phases, with no effect of hospital site, and a potential interaction with procedure type. Particular challenges were encountered in room organization, retrieval of supplies, positioning the patient, and maneuvering the robot.

Direct observation of surgical procedures can help to identify approaches to improve the design of technology and procedures, the training of staff, and configuration of the OR environment, with the eventual goal of improving safety, efficiency and teamwork in high technology surgery. Similar content being viewed by others

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None of the authors has any affiliation or financial involvement that conflicts with the material presented in this report. Author information Authors and Affiliations Corresponding author Ethics declarations Disclosures Jennifer Anger is on the advisory board for Axonics. Lucy Cofran, Tara Cohen, Myrtede Alfred, Falisha Kanji, Eunice Choi, Stephen Savage, and Ken Catchpole have no conflicts of interest or financial ties to disclose. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Supplementary Information Below is the link to the electronic supplementary material. Rights and permissions About this article Cite this article Cofran, L., Cohen, T., Alfred, M. et al. Barriers to safety and efficiency in robotic surgery docking. Surg Endosc 36, 206–215 (2022). https://doi.org/10.1007/s00464-020-08258-0 Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00464-020-08258-0