TY - JOUR
T1 - The value of open conversion simulations during robot-assisted radical prostatectomy
T2 - Implications for robotic training curricula
AU - Zattoni, Fabio
AU - Guttilla, Andrea
AU - Crestani, Alessandro
AU - De Gobbi, Alberto
AU - Cattaneo, Francesco
AU - Moschini, Marco
AU - Vianello, Fabio
AU - Valotto, Claudio
AU - Dal Moro, Fabrizio
AU - Zattoni, Filiberto
PY - 2015/11/1
Y1 - 2015/11/1
N2 - Introduction: There is a lack of protocols, formal guidance, and procedural training regarding open conversions from robot-assisted radical prostatectomy (RARP) to open radical prostatectomy (ORP). An open conversion places complex demands on the healthcare team and has recently been shown to be associated with adverse perioperative outcomes. Aims: To perform a root cause analysis of open conversion simulations from RARP to ORP to identify errors that may contribute to adverse events. Methods: From May 2013 to December 2013, with a team of two surgeons, an anesthesiologist, and three nurses, we simulated 20 emergencies during RARP that require open conversion. A human simulation model was intubated and prepared in the Trendelenburg position; a robot da Vinci SI was locked to it. All simulations were timed, transcribed, and filmed to identify errors and areas for improvement. An institutional conversion protocol was developed at the end of the conversion training. Results: The average conversion time was 130.9 (interquartile range [IQR] 90-201) seconds. Frequencies of the observed errors were as follows: lack of task sequence (70%), errors in robot movements (50%), loss of sterility (50%), space conflict (40%), communication errors (25%), lack of leadership (25%), and accidental fall of surgical devices (25%). Four main strategies were implemented to reduce errors: improving leadership, clearly defining roles, improving knowledge base, and surgical room reorganization. By the last simulation, conversions were performed without errors and using 55.2% less time compared with initial simulations. Conclusions: In this preliminary study, repeated simulations, increased leadership, improved role delineation, and surgical room reorganization enabled faster and less flawed conversions. Further studies are needed to identify if such protocols may translate to actual safety improvement during open conversions.
AB - Introduction: There is a lack of protocols, formal guidance, and procedural training regarding open conversions from robot-assisted radical prostatectomy (RARP) to open radical prostatectomy (ORP). An open conversion places complex demands on the healthcare team and has recently been shown to be associated with adverse perioperative outcomes. Aims: To perform a root cause analysis of open conversion simulations from RARP to ORP to identify errors that may contribute to adverse events. Methods: From May 2013 to December 2013, with a team of two surgeons, an anesthesiologist, and three nurses, we simulated 20 emergencies during RARP that require open conversion. A human simulation model was intubated and prepared in the Trendelenburg position; a robot da Vinci SI was locked to it. All simulations were timed, transcribed, and filmed to identify errors and areas for improvement. An institutional conversion protocol was developed at the end of the conversion training. Results: The average conversion time was 130.9 (interquartile range [IQR] 90-201) seconds. Frequencies of the observed errors were as follows: lack of task sequence (70%), errors in robot movements (50%), loss of sterility (50%), space conflict (40%), communication errors (25%), lack of leadership (25%), and accidental fall of surgical devices (25%). Four main strategies were implemented to reduce errors: improving leadership, clearly defining roles, improving knowledge base, and surgical room reorganization. By the last simulation, conversions were performed without errors and using 55.2% less time compared with initial simulations. Conclusions: In this preliminary study, repeated simulations, increased leadership, improved role delineation, and surgical room reorganization enabled faster and less flawed conversions. Further studies are needed to identify if such protocols may translate to actual safety improvement during open conversions.
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U2 - 10.1089/end.2015.0435
DO - 10.1089/end.2015.0435
M3 - Article
C2 - 26102332
AN - SCOPUS:84946779743
VL - 29
SP - 1282
EP - 1288
JO - Journal of Endourology
JF - Journal of Endourology
SN - 0892-7790
IS - 11
ER -