ABSTRACT
OBJECTIVES: To design a data collection methodology to capture team activities during robot-assisted surgery (RAS) (team communications, surgical flow, and procedural interruptions), and use relevant disciplines of Industrial Engineering and Human Factors Engineering to uncover key issues impeding surgical flow and guide evidence-based strategic changes to enhance surgical performance and improve outcomes. DESIGN: Field study, to determine the feasibility of the proposed methodology. SETTING: Recording the operating room (OR) environment during robot-assisted surgeries (RAS). The data collection system included recordings from the console and 3 aerial cameras, in addition to 8 lapel microphones (1 for each OR team member). Questionnaires on team familiarity and cognitive load were collected. PARTICIPANTS: In all, 37 patients and 89 OR staff members have consented to participate in the study. RESULTS: Overall, 37 RAS procedures were recorded (130 console hours). A pilot procedure was evaluated in detail. We were able to characterize team communications in terms of flow, mode, topic, and form. Surgical flow was evaluated in terms of duration, location, personnel involved, purpose, and if movements were avoidable or not. Procedural interruptions were characterized according to their duration, cause, mode of communication, and personnel involved. CONCLUSION: This methodology allowed for the capture of a wide variety of team activities during RAS that would serve as a solid platform to improve nontechnical aspects of RAS.
Subject(s)
Operating Rooms , Patient Care Team , Robotic Surgical Procedures , Task Performance and Analysis , Communication , Data Collection , Efficiency , Environment , Ergonomics , Feasibility Studies , Humans , Quality Improvement , Surveys and QuestionnairesABSTRACT
OBJECTIVE: To determine short-term health-related quality of life (HRQL) outcomes after robot-assisted radical cystectomy (RARC) using the Bladder Cancer Index (BCI) and European Organisation for Research and Treatment of Cancer (EORTC) Body Image Scale (BIS). PATIENTS AND METHODS: All patients undergoing RARC were enrolled in a quality assurance database. The patients completed two validated questionnaires, BCI and BIS, preoperatively and at standardised postoperative intervals. The primary outcome measure was difference in interval and baseline BCI and BIS scores. Complications were identified and classified by Clavien grade. RESULTS: In all, 43 patients completed pre- and postoperative questionnaires There was a decline in the urinary domain at 0-1 month after RARC (P = 0.006), but this returned to baseline by 1-2 months. There was a decline in the bowel domain at 0-1 month (P < 0.001) and 1-2 months (P = 0.024) after RARC, but this returned to baseline by 2-4 months. The decline in BCI scores was greatest for the sexual function domain, but this returned to baseline by 16-24 months after RARC. Body image perception using BIS showed no significant change after RARC except at the 4-10 months period (P = 0.018). CONCLUSIONS: Based on BCI and BIS scores HRQL outcomes after RARC show recovery of urinary and bowel domains ≤6 months. Longer follow-up with a larger cohort of patients will help refine HRQL outcomes.
