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Randomized Controlled Trial
. 2025 Sep;39(9):5820-5829.
doi: 10.1007/s00464-025-12006-7. Epub 2025 Jul 22.

Robotic malfunction checklist: a guide to operating room safety, efficiency, and surgeon autonomy

Alexis Desir  1 , Kaustubh Gopal  1 , John Norton  1 , Herbert J Zeh 3rd  1 , Ganesh Sankaranarayanan  2
Affiliations
Randomized Controlled Trial

Robotic malfunction checklist: a guide to operating room safety, efficiency, and surgeon autonomy

Alexis Desir et al. Surg Endosc. 2025 Sep.

Abstract

Importance: Surgical robots encounter malfunctions requiring swift resolution, impacting patient safety and surgical efficiency. A Robotic Malfunction Checklist (RMC) may enhance surgical team autonomy reduce stress and intraoperative downtime.

Objective: To assess the efficacy of a step-by-step RMC for troubleshooting surgical robot errors through a randomized controlled trial simulation.

Design: An IRB-approved study conducted a needs analysis to identify common robotic errors. A specialized RMC was then developed and tested in a randomized simulation setting, utilizing the da Vinci Xi system.

Setting: Simulation environment utilizing the da Vinci Xi surgical robot system.

Participants: Thirty-one participants, including surgery residents and attendings were allocated to either the control (n = 16) or experimental groups (n = 15).

Interventions: Control group participants addressed errors conventionally, while experimental group members utilized the RMC for troubleshooting.

Main outcomes and measures: Post-survey data, including NASA Task Load Index (TLX) scores were collected to assess task load and confidence in troubleshooting. Statistical analysis involved the Mann-Whitney U test and Fischer's exact test.

Results: The experimental group significantly expedited resolution of the third complex error (3.9 min; IQR = 5.2; P < 0.01), representing a 43% reduction in resolution time. Task load was notably lower in the experimental group across all TLX domains for error 3 and in 4 out of 5 domains for error 2 (P < .05). Experimental group members expressed increased confidence in troubleshooting in live patient settings if provided with the RMC.

Conclusions and relevance: ARMC reduced the time to resolve robotic errors and decreased stress load on surgeons. These promising findings advocate for further evaluation and potential implementation of the RMC in live operative settings.

Keywords: Da VINCI Xi; Robotic malfunction; Simulation.

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Conflict of interest statement

Declarations. Disclosures: Alexis Desir, Kaustubh Gopal, John Norton, and Ganesh Sankaranarayanan have no conflicts of interest or financial ties to disclose. Herbert J. Zeh III: On the SST Scientific Advisory Board for which he received stock options.

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