scholarly journals Factors supporting and constraining the implementation of robot-assisted surgery: a realist interview study

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e028635 ◽  
Author(s):  
Rebecca Randell ◽  
Stephanie Honey ◽  
Natasha Alvarado ◽  
Joanne Greenhalgh ◽  
Jon Hindmarsh ◽  
...  
Keyword(s):  
Interview Study ◽  
Routine Practice ◽  
Team Leaders ◽  
Robot Assisted ◽  
Team Members ◽  
Initial Decision ◽  
Surgical Trainees ◽  
Theatre Staff ◽  
Operation Duration ◽  
Robot Assisted Surgery

ObjectiveTo capture stakeholders’ theories concerning how and in what contexts robot-assisted surgery becomes integrated into routine practice.DesignA literature review provided tentative theories that were revised through a realist interview study. Literature-based theories were presented to the interviewees, who were asked to describe to what extent and in what ways those theories reflected their experience. Analysis focused on identifying mechanisms through which robot-assisted surgery becomes integrated into practice and contexts in which those mechanisms are triggered.SettingNine hospitals in England where robot-assisted surgery is used for colorectal operations.ParticipantsForty-four theatre staff with experience of robot-assisted colorectal surgery, including surgeons, surgical trainees, theatre nurses, operating department practitioners and anaesthetists.ResultsInterviewees emphasised the importance of support from hospital management, team leaders and surgical colleagues. Training together as a team was seen as beneficial, increasing trust in each other’s knowledge and supporting team bonding, in turn leading to improved teamwork. When first introducing robot-assisted surgery, it is beneficial to have a handpicked dedicated robotic team who are able to quickly gain experience and confidence. A suitably sized operating theatre can reduce operation duration and the risk of de-sterilisation. Motivation among team members to persist with robot-assisted surgery can be achieved without involvement in the initial decision to purchase a robot, but training that enables team members to feel confident as they take on the new tasks is essential.ConclusionsWe captured accounts of how robot-assisted surgery has been introduced into a range of hospitals. Using a realist approach, we were also able to capture perceptions of the factors that support and constrain the integration of robot-assisted surgery into routine practice. We have translated these into recommendations that can inform future implementations of robot-assisted surgery.

scholarly journals Anticipation, teamwork and cognitive load: chasing efficiency during robot-assisted surgery

2017 ◽  
Vol 27 (2) ◽  
pp. 148-154 ◽  
Author(s):  
Kevin Sexton ◽  
Amanda Johnson ◽  
Amanda Gotsch ◽  
Ahmed A Hussein ◽  
Lora Cavuoto ◽  
...  
Keyword(s):  
Cognitive Load ◽  
Operative Time ◽  
Pearson Correlation ◽  
Surgical Team ◽  
Robot Assisted ◽  
Team Members ◽  
Task Load ◽  
Video And Audio ◽  
Team Familiarity ◽  
Robot Assisted Surgery

IntroductionRobot-assisted surgery (RAS) has changed the traditional operating room (OR), occupying more space with equipment and isolating console surgeons away from the patients and their team. We aimed to evaluate how anticipation of surgical steps and familiarity between team members impacted efficiency.MethodsWe analysed recordings (video and audio) of 12 robot-assisted radical prostatectomies. Any requests between surgeon and the team members were documented and classified by personnel, equipment type, mode of communication, level of inconvenience in fulfilling the request and anticipation. Surgical team members completed questionnaires assessing team familiarity and cognitive load (National Aeronautics and Space Administration – Task Load Index). Predictors of team efficiency were assessed using Pearson correlation and stepwise linear regression.Results1330 requests were documented, of which 413 (31%) were anticipated. Anticipation correlated negatively with operative time, resulting in overall 8% reduction of OR time. Team familiarity negatively correlated with inconveniences. Anticipation ratio, per cent of requests that were non-verbal and total request duration were significantly correlated with the console surgeons’ cognitive load (r=0.77, p=0.006; r=0.63, p=0.04; and r=0.70, p=0.02, respectively).ConclusionsAnticipation and active engagement by the surgical team resulted in shorter operative time, and higher familiarity scores were associated with fewer inconveniences. Less anticipation and non-verbal requests were also associated with lower cognitive load for the console surgeon. Training efforts to increase anticipation and team familiarity can improve team efficiency during RAS.

scholarly journals A realist process evaluation of robot-assisted surgery: integration into routine practice and impacts on communication, collaboration and decision-making

2017 ◽  
Vol 5 (20) ◽  
pp. 1-140 ◽  
Author(s):  
Rebecca Randell ◽  
Stephanie Honey ◽  
Jon Hindmarsh ◽  
Natasha Alvarado ◽  
Joanne Greenhalgh ◽  
...  
Keyword(s):  
Decision Making ◽  
Process Evaluation ◽  
Video Recording ◽  
Team Training ◽  
Routine Practice ◽  
Successful Implementation ◽  
Robot Assisted ◽  
Cancer Trial ◽  
The Impact ◽  
Robot Assisted Surgery

BackgroundThe implementation of robot-assisted surgery (RAS) can be challenging, with reports of surgical robots being underused. This raises questions about differences compared with open and laparoscopic surgery and how best to integrate RAS into practice.ObjectivesTo (1) contribute to reporting of the ROLARR (RObotic versus LAparoscopic Resection for Rectal cancer) trial, by investigating how variations in the implementation of RAS and the context impact outcomes; (2) produce guidance on factors likely to facilitate successful implementation; (3) produce guidance on how to ensure effective teamwork; and (4) provide data to inform the development of tools for RAS.DesignRealist process evaluation alongside ROLARR. Phase 1 – a literature review identified theories concerning how RAS becomes embedded into practice and impacts on teamwork and decision-making. These were refined through interviews across nine NHS trusts with theatre teams. Phase 2 – a multisite case study was conducted across four trusts to test the theories. Data were collected using observation, video recording, interviews and questionnaires. Phase 3 – interviews were conducted in other surgical disciplines to assess the generalisability of the findings.FindingsThe introduction of RAS is surgeon led but dependent on support at multiple levels. There is significant variation in the training provided to theatre teams. Contextual factors supporting the integration of RAS include the provision of whole-team training, the presence of handpicked dedicated teams and the availability of suitably sized operating theatres. RAS introduces challenges for teamwork that can impact operation duration, but, over time, teams develop strategies to overcome these challenges. Working with an experienced assistant supports teamwork, but experience of the procedure is insufficient for competence in RAS and experienced scrub practitioners are important in supporting inexperienced assistants. RAS can result in reduced distraction and increased concentration for the surgeon when he or she is supported by an experienced assistant or scrub practitioner.ConclusionsOur research suggests a need to pay greater attention to the training and skill mix of the team. To support effective teamwork, our research suggests that it is beneficial for surgeons to (1) encourage the team to communicate actions and concerns; (2) alert the attention of the assistant before issuing a request; and (3) acknowledge the scrub practitioner’s role in supporting inexperienced assistants. It is beneficial for the team to provide oral responses to the surgeon’s requests.LimitationsThis study started after the trial, limiting impact on analysis of the trial. The small number of operations observed may mean that less frequent impacts of RAS were missed.Future workFuture research should include (1) exploring the transferability of guidance for effective teamwork to other surgical domains in which technology leads to the physical or perceptual separation of surgeon and team; (2) exploring the benefits and challenges of including realist methods in feasibility and pilot studies; (3) assessing the feasibility of using routine data to understand the impact of RAS on rare end points associated with patient safety; (4) developing and evaluating methods for whole-team training; and (5) evaluating the impact of different physical configurations of the robotic console and team members on teamwork.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

scholarly journals The Clinical Application of Robot-Assisted Ventriculoperitoneal Shunting in the Treatment of Hydrocephalus

2021 ◽  
Vol 15 ◽  
Author(s):  
De-feng Liu ◽  
Huan-guang Liu ◽  
Kai Zhang ◽  
Fan-gang Meng ◽  
An-chao Yang ◽  
...  
Keyword(s):  
Blood Loss ◽  
Success Rate ◽  
Hole Diameter ◽  
The Other ◽  
Intraoperative Blood Loss ◽  
Robot Assisted ◽  
Surgery Group ◽  
Ventriculoperitoneal Shunting ◽  
Operation Duration ◽  
Robot Assisted Surgery

BackgroundThis work aims to assess the effectiveness and safety of robotic assistance in ventriculoperitoneal shunting and to compare the results with data from traditional surgery.MethodsWe retrospectively analyzed 60 patients who had undergone ventriculoperitoneal shunting, of which shunts were implanted using a robot in 20 patients and using traditional surgical methods in the other 40 patients. Data related to surgery were compared between the two groups, and the accuracy of the drainage tube in the robot-assisted group was assessed.ResultsIn the robot-assisted surgery group, the operation duration was 29.75 ± 6.38 min, intraoperative blood loss was 10.0 ± 3.98 ml, the success rate of a single puncture was 100%, and the bone hole diameter was 4.0 ± 0.3 mm. On the other hand, the operation duration was 48.63 ± 6.60 min, intraoperative blood loss was 22.25 ± 4.52 ml, the success rate of a single puncture was 77.5%, and the bone hole diameter was 11.0 ± 0.2 mm in the traditional surgery group. The above are statistically different between the two groups (P < 0.05). Only one case of surgery-related complications occurred in the robot-assisted group, while 13 cases occurred in the traditional surgery group. There was no significant difference in the hospitalization time. In the robot-assisted surgery group, the average radial error was 2.4 ± 1.5 mm and the average axial error was 1.9 ± 2.1 mm.ConclusionIn summary, robot-assisted implantation is accurate, simple to operate, and practical; the duration of surgery is short; trauma to the patient is reduced; and fewer postoperative complications related to surgery are reported.

scholarly journals “Put the what, where? Cut here?!” challenges to coordinating attention in robot-assisted surgery: a microanalytic pilot study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e046132
Author(s):  
Antara Satchidanand ◽  
Jeff Higginbotham ◽  
Ann Bisantz ◽  
Naif Aldhaam ◽  
Ahmed Elsayed ◽  
...  
Keyword(s):  
Pilot Study ◽  
Effective Means ◽  
Relative Timing ◽  
Robot Assisted ◽  
Functional Movement ◽  
Team Members ◽  
Environmental Support ◽  
Communicative Efficiency ◽  
Insight Into ◽  
Robot Assisted Surgery

IntroductionDuring robot-assisted surgery (RAS), changes to the operating room configuration pose challenges to communication by limiting team members’ ability to see one another or use gesture. Referencing (the act of pointing out an object or area in order to coordinate action around it), may be susceptible to miscommunication due to these constraints.ObjectivesExplore the use of microanalysis to describe and evaluate communicative efficiency in RAS through examination of referencing in surgical tasks.MethodsAll communications during ten robot-assisted pelvic surgeries (radical cystectomies and prostatectomies) were fully transcribed. Forty-six referencing events were identified within these and subjected to a process of microanalysis. Microanalysis employs detailed transcription of speech and gesture along with their relative timing/sequencing to describe and analyse interactions. A descriptive taxonomy for referencing strategies was developed with categories including references reliant exclusively on speech (anatomic terms/directional language and context dependent words (CD)); references reliant exclusively on gesture or available aspects of the environment (point/show, camera focus/movement in the visual field and functional movement); and references reliant on the integrated use of speech and gesture/environmental support (integrated communication (IC)). Frequency of utilisation and number/percent ‘miscommunication’, were collated within each category when miscommunication was defined as any reference met with incorrect or no identification of the target.ResultsIC and CD were the most frequently used strategies (45% and 26%, respectively, p≤0.01). Miscommunication was encountered in 22% of references. The use of IC resulted in the fewest miscommunications, while CD was associated with the most miscommunications (42%). Microanalysis provided insight into the causes and nature of successful referencing and miscommunication.ConclusionsIn RAS, surgeons complete referencing tasks in a variety of ways. IC may provide an effective means of referencing, while other strategies may not be adequately supported by the environment.

Do People Trust in Robot-Assisted Surgery? Evidence from Europe (Preprint)

2020 ◽  
Author(s):  
Joan Torrent-Sellens ◽  
Ana Jiménez-Zarco ◽  
Francesc Saigí-Rubió
Keyword(s):  
Technology Acceptance ◽  
Surgical Intervention ◽  
Negative Relationship ◽  
Predictor Variable ◽  
Major Change ◽  
Ease Of Use ◽  
The European Union ◽  
Robot Assisted ◽  
Surgical Interventions ◽  
Robot Assisted Surgery

BACKGROUND Increasingly intelligent and autonomous robots are destined to have a huge impact on our society. Their adoption, however, represents a major change to the healthcare sector’s traditional practices, which, in turn, poses certain challenges. To what extent is it possible to foresee a near-future scenario in which minor routine surgery is directed by robots? And what are the patients’ or general public’s perceptions of having surgical procedures performed on them by robots, be it totally or partially? A patient’s trust in robots and AI may facilitate the spread and use of such technologies. OBJECTIVE The goal of our study was to establish the factors that influence how people feel about having a medical operation performed on them by a robot. METHODS We used data from a 2017 Flash Eurobarometer (number 460) of European Commission with 27,901 citizens aged 15 years and over in the 28 countries of the European Union. The research designs and tests a technology acceptance model (TAM). Logistic regression (odds ratios, OR) to model the predictors of trust in robot-assisted surgery was calculated through motivational factors, robots using experience and sociodemographic independent variables. RESULTS The negative relationship between most of the predictors of ease of use, expected benefits and attitude towards robots, and confidence in robot-assisted surgery was contrasted. The only non-sociodemographic predictor variable that has a positive relationship with trust in robots participating in a surgical intervention is previous experience in the use of robots. In this context, we analyze the confidence predictors for three different levels of robot use experience (zero use, average use, and high use). The results obtained indicate that, as the experience of using robots increases, the predictive coefficients related to information, attitude and perception of robots become more negative. Research results also determined that variables of a sociodemographic nature played an important predictive role. It was confirmed that the effect of experience on trust in robots for surgical interventions was greater among men, people between 40 and 54 years old, and those with higher educational levels. CONCLUSIONS Despite the considerable benefits for the patient that the use of robots can bring in a surgical intervention, the results obtained show that trust in robots goes beyond rational decision-making. By contrasting the reasons that generate trust and mistrust in robots, especially by highlighting the experience of use as a key element, the research makes a new contribution to the state of the art and draws practical implications of the use of robots for health policy and practice.

scholarly journals Telemanipulation of an Articulated Robotic Arm using a Commercial Virtual Reality Controller

2020 ◽  
Vol 6 (3) ◽  
pp. 127-130
Author(s):  
Max B. Schäfer ◽  
Kent W. Stewart ◽  
Nico Lösch ◽  
Peter P. Pott
Keyword(s):  
Virtual Reality ◽  
Real Time ◽  
Robotic Arm ◽  
Input Device ◽  
Robot Assisted ◽  
Promising Alternative ◽  
Input Devices ◽  
Current Input ◽  
Current Systems ◽  
Robot Assisted Surgery

AbstractAccess to systems for robot-assisted surgery is limited due to high costs. To enable widespread use, numerous issues have to be addressed to improve and/or simplify their components. Current systems commonly use universal linkage-based input devices, and only a few applicationoriented and specialized designs are used. A versatile virtual reality controller is proposed as an alternative input device for the control of a seven degree of freedom articulated robotic arm. The real-time capabilities of the setup, replicating a system for robot-assisted teleoperated surgery, are investigated to assess suitability. Image-based assessment showed a considerable system latency of 81.7 ± 27.7 ms. However, due to its versatility, the virtual reality controller is a promising alternative to current input devices for research around medical telemanipulation systems.

scholarly journals A Survey on Robotic Technologies for Forest Firefighting: Applying Drone Swarms to Improve Firefighters’ Efficiency and Safety

2021 ◽  
Vol 11 (1) ◽  
pp. 363
Author(s):  
Juan Jesús Roldán-Gómez ◽  
Eduardo González-Gironda ◽  
Antonio Barrientos
Keyword(s):  
Augmented Reality ◽  
Access To Information ◽  
Team Leaders ◽  
Team Members ◽  
Multiple Tasks ◽  
Different Types ◽  
Complete Survey ◽  
Virtual And Augmented Reality ◽  
Robotic Technologies

Forest firefighting missions encompass multiple tasks related to prevention, surveillance, and extinguishing. This work presents a complete survey of firefighters on the current problems in their work and the potential technological solutions. Additionally, it reviews the efforts performed by the academy and industry to apply different types of robots in the context of firefighting missions. Finally, all this information is used to propose a concept of operation for the comprehensive application of drone swarms in firefighting. The proposed system is a fleet of quadcopters that individually are only able to visit waypoints and use payloads, but collectively can perform tasks of surveillance, mapping, monitoring, etc. Three operator roles are defined, each one with different access to information and functions in the mission: mission commander, team leaders, and team members. These operators take advantage of virtual and augmented reality interfaces to intuitively get the information of the scenario and, in the case of the mission commander, control the drone swarm.

Sign in / Sign up

Export Citation Format

Share Document