@Article{,
AUTHOR = {Christopher J. Dru, Jennifer T. Anger, Colby P. Souders, Catherine Bresee, Matthias Weigl, Elyse Hallett, Ken Catchpole},
TITLE = {Surgical flow disruptions during robotic-assisted radical prostatectomy},
JOURNAL = {Canadian Journal of Urology},
VOLUME = {24},
YEAR = {2017},
NUMBER = {3},
PAGES = {8814--8821},
URL = {http://www.techscience.com/CJU/v24n3/60950},
ISSN = {1488-5581},
ABSTRACT = {<b>Introduction:</b> We sought to apply the principles of human factors research to robotic-assisted radical prostatectomy to understand where training and integration challenges lead to suboptimal and inefficient care.<br/>

<b>Materials and methods:</b> Thirty-four robotic-assisted radical prostatectomy and bilateral pelvic lymph node dissections over a 20 week period were observed for flow disruptions (FD) - deviations from optimal care that can compromise safety or efficiency. Other variables - physician experience, trainee involvement, robot model (S versus Si), age, body mass index (BMI), and American Society of Anesthesiologists (ASA) physical status - were used to stratify the data and understand the effect of context. Effects were studied across four operative phases - entry to insufflations, robot docking, surgical intervention, and undocking. FDs were classified into one of nine categories.<br/>

<b>Results:</b> An average of 9.2 (SD = 3.7) FD/hr were recorded, with the highest rates during robot docking (14.7 [SD = 4.3] FDs/hr). The three most common flow disruptions were disruptions of communication, coordination, and equipment. Physicians with more robotic experience were faster during docking (p < 0.003). Training cases had a greater FD rate (8.5 versus 10.6, p < 0.001), as did the Si model robot (8.2 versus 9.8, p = 0.002). Patient BMI and ASA classification yielded no difference in operative duration, but had phase-specific differences in FD.<br/>

<b>Conclusions:</b> Our data reflects the demands placed on the OR team by the patient, equipment, environment and context of a robotic surgical intervention, and suggests opportunities to enhance safety, quality, efficiency, and learning in robotic surgery.},
DOI = {}
}