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. 2016 Jul;118(1):132-9.
doi: 10.1111/bju.13426. Epub 2016 Feb 21.

Ambulatory movements, team dynamics and interactions during robot-assisted surgery

Nabeeha Ahmad  1 , Ahmed A Hussein  1   2 , Lora Cavuoto  1   3 , Mohamed Sharif  1 , Jenna C Allers  1 , Nobuyuki Hinata  4 , Basel Ahmad  1 , Justen D Kozlowski  1 , Zishan Hashmi  1 , Ann Bisantz  1   3 , Khurshid A Guru  1
Affiliations

Ambulatory movements, team dynamics and interactions during robot-assisted surgery

Nabeeha Ahmad et al. BJU Int. 2016 Jul.

Abstract

Objective: To analyse ambulatory movements and team dynamics during robot-assisted surgery (RAS), and to investigate whether congestion of the physical space associated with robotic technology led to workflow challenges or predisposed to errors and adverse events.

Methods: With institutional review board approval, we retrospectively reviewed 10 recorded robot-assisted radical prostatectomies in a single operating room (OR). The OR was divided into eight zones, and all movements were tracked and described in terms of start and end zones, duration, personnel and purpose. Movements were further classified into avoidable (can be eliminated/improved) and unavoidable (necessary for completion of the procedure).

Results: The mean operating time was 166 min, of which ambulation constituted 27 min (16%). A total of 2 896 ambulatory movements were identified (mean: 290 ambulatory movements/procedure). Most of the movements were procedure-related (31%), and were performed by the circulating nurse. We identified 11 main pathways in the OR; the heaviest traffic was between the circulating nurse zone, transit zone and supply-1 zone. A total of 50% of ambulatory movements were found to be avoidable.

Conclusion: More than half of the movements during RAS can be eliminated with an improved OR setting. More studies are needed to design an evidence-based OR layout that enhances access, workflow and patient safety.

Keywords: disruption; error; layout; operating time; robot; robotic surgery; surgical flow.

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Conflict of interest statement

Conflicts of Interest

None disclosed.

Figures

Figure 1
Figure 1
Photo demonstrating the congestion of the RAS OR. Image shows the Sterile Zone during surgery as viewed from Transit Zone 1.
Figure 2
Figure 2
Figure 2a. The eight zones of the OR. Figure 2b. Spaghetti Diagram illustrating the 11 major pathways. Average use of each pathway during 10 procedures is represented as (n). The red circle highlights the area of heaviest traffic Figure 2c. Most common pathway usage by
Figure 2
Figure 2
Figure 2a. The eight zones of the OR. Figure 2b. Spaghetti Diagram illustrating the 11 major pathways. Average use of each pathway during 10 procedures is represented as (n). The red circle highlights the area of heaviest traffic Figure 2c. Most common pathway usage by
Figure 3
Figure 3
Number of ambulatory movements per person divided based on classification. *It is important to note that the Physician Assistant had 10 total movements documented, all of which occurred in a single procedure (Procedure 2).
Figure 4
Figure 4
Overall prevalence of different ambulatory movements. The sum of avoidable and unavoidable movements represents the overall percentage of movements per classification
See this image and copyright information in PMC

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