ABSTRACT
BACKGROUND AND PURPOSE: A current dilemma is how to incorporate robot assisted laparoscopic radical prostatectomy (RALP) into residency/fellowship programs while containing costs and maintaining acceptable operative times. We prospectively analyzed factors that affect the time of nine separate RALP steps performed in a residency/fellowship training program incorporating the da Vinci robot. MATERIALS AND METHODS: A prospective evaluation of 50 consecutive RALP performed by a single surgeon while incorporating trainees was completed. RALP was divided into nine segments, and time of each segment was recorded in minutes. Who performed each portion of the procedure (resident, fellow, or attending surgeon) was also analyzed. The effects of clinical and prostate cancer characteristics were analyzed statistically to investigate associations with procedure completion times for each of the nine segments. Outcomes, including complications and urinary continence, were recorded. RESULTS: Mean age was 58 years, and body mass index was 30 kg/m(2). Mean prostate size was 49.2 grams. Nine patients (18%) had pathologic T(3) disease, and 10 patients (20%) had positive surgical margins. Median total operative time was 276 minutes (range 245-330 min). There was no statistical association with any clinical parameter prolonging total operative time or those of the nine individual steps of the operation. Locally weighted smooth time plots demonstrate stable decreases in all segments with experience. The slowest decreases were seen in bladder neck and neurovascular bundle times. Anastomosis time fluctuated the most. CONCLUSION: RALP can be incorporated successfully into a residency/fellowship training program with acceptable operative times and outcomes even while the supervising physician is on his "learning curve."
Subject(s)
Fellowships and Scholarships , Internship and Residency , Laparoscopy/methods , Prostatectomy/education , Robotics/education , Aged , Humans , Male , Middle Aged , Prostatic Neoplasms/surgery , Time Factors , Treatment OutcomeABSTRACT
Robotic technology and the increased use of minimally invasive surgery approaches is altering the environment in which operating room personnel work and affecting how nurses must care for patients. An understanding of the history of robotics, current applications of the technology, and perioperative nursing responsibilities is needed to assure quality patient care in the wake of continued advances in technology.
Subject(s)
Minimally Invasive Surgical Procedures/nursing , Perioperative Care/nursing , Perioperative Nursing/organization & administration , Robotics/organization & administration , Forecasting , Humans , Minimally Invasive Surgical Procedures/methods , Minimally Invasive Surgical Procedures/trends , Nurse's Role , Nursing Assessment , Patient Care Planning , Perioperative Care/organization & administration , Perioperative Nursing/education , Robotics/education , Technology Assessment, BiomedicalABSTRACT
Laparoscopic pyeloplasty as a treatment for ureteropelvic junction obstruction has shown comparable success rates with open pyeloplasty techniques. The use of robotic technology to assist during laparoscopic pyeloplasty procedures has been encouraged by the steep learning curve for laparoscopic surgical skills, and the complexity of laparoscopic suturing. Robotic technology provides the surgeon with the ability to filter out any physiologic hand tremor, more degrees of freedom of movement than traditional laparoscopic instruments, the ability to scale movement to provide better control for microsurgery, better ergonomics during surgery, and three-dimensional vision. Details of the procedure and specific nursing care of the patient undergoing robotic-assisted laparoscopic pyeloplasty at the University of Iowa Hospital and Clinics are described.
Subject(s)
Kidney Pelvis/surgery , Perioperative Care/nursing , Robotics , Ureteral Obstruction/surgery , Ureteroscopy/nursing , Academic Medical Centers , Aftercare , Ergonomics , Humans , Interior Design and Furnishings , Iowa , Nurse's Role , Nursing Assessment , Patient Discharge , Patient Education as Topic , Perioperative Care/methods , Perioperative Nursing/methods , Robotics/methods , Treatment Outcome , Ureteral Obstruction/nursing , Ureteroscopy/methodsABSTRACT
Use of robotics is expanding rapidly in the medical arena. Not only are a growing number of facilities purchasing robotic systems, but the number of surgeons using them also is increasing, which creates many challenges (eg, cost, training, safety). The evolution of robotics in surgery is presented within the context of virtual reality, telepresence, telemanipulation, and passive (ie, master-slave) robotic surgical systems. A new perioperative nursing role, the robotics nurse specialist, was developed and implemented at one facility. The need for a robotics nurse specialist and how this role can help the entire surgical team promote positive patient and facility outcomes also is discussed.
