Anthony Manuguerra1,2, Charles Mazeaud3, Nicolas Hubert4, Pascal Eschwège3,5,6, Mathieu Roumiguié7, Julia Salleron8, Jacques Hubert3,9. 1. Department of Urology, CHRU Nancy Brabois University Hospital, 5 Rue du Morvan, 54500, Vandoeuvre-Lès-Nancy, France. a.manuguerra@chru-nancy.fr. 2. Department of Surgery, Institut de Cancérologie de Lorraine, Université de Lorraine, 54519, Vandoeuvre-Lès-Nancy, France. a.manuguerra@chru-nancy.fr. 3. Department of Urology, CHRU Nancy Brabois University Hospital, 5 Rue du Morvan, 54500, Vandoeuvre-Lès-Nancy, France. 4. Department of Urology, Gentilly Polyclinic, Nancy, France. 5. Department of Surgery, Institut de Cancérologie de Lorraine, Université de Lorraine, 54519, Vandoeuvre-Lès-Nancy, France. 6. Unité de Biologie Des Tumeurs CNRS-CRAN UMR 7039, Vandoeuvre-Lès-Nancy, France. 7. Department of Urology, Toulouse Rangueuil University Hospital, Toulouse, France. 8. Department of Biostatistics, Institut de Cancérologie de Lorraine, Université de Lorraine, 54519, Vandoeuvre-Lès- Nancy, France. 9. IADI-UL-INSERM (U1254), University Hospital, Nancy, France.
Abstract
BACKGROUND: Robotic surgery requires a set of non-technical skills (NTS), because of the complex environment. We aim to study relationship between NTS and near-miss events in robotic surgery. METHODS: This is an observational study in five French centers. Three robotic procedures were observed and filmed by one of expert trainers in NTS. They established and scored a non-technical skills in robotic surgery (NTSRS) score, that included eight items, each scored from 1 to 5, to assess the whole surgical teams. The surgical teams also self-assessed their work. The number of near-miss events was recorded and classified as minor, or major but no harm incidents, independently by two surgeons. Correlations were Spearman coefficients. RESULTS: Of the 26 procedures included, 15 were prostatectomy (58%), 9 nephrectomy (35%), and 2 pyeloplasty (7.7%). Half of procedures (n = 13) were performed by surgeons with extensive RS experience (more than 150 procedures). Per procedure, there was a median (quartiles) of 9 (7; 11) near-miss events. There was 1 (0; 2) major near-miss events, with no harm. The median NTSRS score was 18 (14; 21), out of 40. The number of near-miss events was strongly correlated with the NTSRS score (r = - 0.92, p < 0.001) but was not correlated with the surgeon's experience. The surgeons for fifteen (58%) procedures, and the bed-side surgeons for 11 (42%) procedures, felt that there was no need for an improvement in the quality of their NTS. None of the surgeons gave a negative self-evaluation for any procedure; in three procedures (12%), the bed-side surgeons self-assessed negatively, on ergonomics. CONCLUSION: Occurrence of near-miss events was reduced in teams managing NTS. Specific NTS surgical team training is essential for robotic surgery as it may have a significant impact on risk management.
BACKGROUND: Robotic surgery requires a set of non-technical skills (NTS), because of the complex environment. We aim to study relationship between NTS and near-miss events in robotic surgery. METHODS: This is an observational study in five French centers. Three robotic procedures were observed and filmed by one of expert trainers in NTS. They established and scored a non-technical skills in robotic surgery (NTSRS) score, that included eight items, each scored from 1 to 5, to assess the whole surgical teams. The surgical teams also self-assessed their work. The number of near-miss events was recorded and classified as minor, or major but no harm incidents, independently by two surgeons. Correlations were Spearman coefficients. RESULTS: Of the 26 procedures included, 15 were prostatectomy (58%), 9 nephrectomy (35%), and 2 pyeloplasty (7.7%). Half of procedures (n = 13) were performed by surgeons with extensive RS experience (more than 150 procedures). Per procedure, there was a median (quartiles) of 9 (7; 11) near-miss events. There was 1 (0; 2) major near-miss events, with no harm. The median NTSRS score was 18 (14; 21), out of 40. The number of near-miss events was strongly correlated with the NTSRS score (r = - 0.92, p < 0.001) but was not correlated with the surgeon's experience. The surgeons for fifteen (58%) procedures, and the bed-side surgeons for 11 (42%) procedures, felt that there was no need for an improvement in the quality of their NTS. None of the surgeons gave a negative self-evaluation for any procedure; in three procedures (12%), the bed-side surgeons self-assessed negatively, on ergonomics. CONCLUSION: Occurrence of near-miss events was reduced in teams managing NTS. Specific NTS surgical team training is essential for robotic surgery as it may have a significant impact on risk management.
Authors: Louise Hull; Sonal Arora; Rajesh Aggarwal; Ara Darzi; Charles Vincent; Nick Sevdalis Journal: J Am Coll Surg Date: 2011-12-24 Impact factor: 6.113