Establishment of a 24/7 robotic acute care surgery program at a large academic medical center

Abstract

Background: For many years, robotic surgery has been an option for various elective surgical procedures. Though robotic surgery has not traditionally been the first choice for acute surgical patients, recent work has shown promise in broader applications. However, there are limited data regarding how to establish an institutional robotics program for higher acuity patients. This project aimed to map a pathway for the creation of an acute care surgery robotic program at a large academic medical center.

Methods: Various stakeholders were gathered jointly with our surgical faculty: anesthesia, operating room leadership, surgical technologists, circulating nurses, Central Sterile Supply, and Intuitive Surgical Inc. representatives. Staff underwent robotics training, and surgical technologists were trained as bedside first assistants. Nontraditional robotic operating rooms were allocated for coordinated placement of appropriate cases, and pre-made case carts were arranged with staff to be available at all hours. A workflow was created between surgical faculty and staff to streamline add-on robotic cases to the daily schedule.

Results: Six faculty and two fellows are now credentialed in robotics surgery, and additional surgeons are undergoing training. Numerous staff have completed training to perform operative assistant duties. The operating capacity of robotic acute care surgeries has more than doubled in just one year, from 77 to 172 cases between 2022 and 2023, respectively. Two add-on cases can be accommodated per day. Select patients are being offered robotic surgeries in the acute surgical setting, and ongoing efforts are being made to create guidelines for which patients would best benefit from robotic procedures.

Conclusions: Launching a successful robotic surgery program requires a coordinated, multidisciplinary effort to ensure seamless integration into daily operations. Additional assistance from outside technology representatives can help to ensure comfort with procedures. Further studies are needed to determine the acute patient population that may benefit most from robotic surgery.

Keywords: Acute care surgery; Emergency general surgery; Laparoscopic surgery; Minimally invasive surgery; Robotic surgery; Robotic surgery program.

Fig. 1

Workflow for robotic acute care surgery cases at our institution. These are the steps required to identify both a case and surgeon so they can be added onto the operating room schedule each day

Fig. 2

Increase in robotic acute care surgery cases performed at OSU from 2022 to 2023. Since robotic acute care surgical cases began being performed at OSU in early 2022, the number of robotic cases completed has steadily increased. Data are stratified by quarterly totals per calendar year (2022, n = 77; 2023, n = 172)