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Background: Robot-assisted surgery is expanding worldwide. Most research in this field concentrates on surgeons’ technical skills and patient outcome, but research from open and laparoscopic surgery shows that teamwork is crucial for patient safety. Team composition is changed in robot-assisted surgery with the surgeon placed away from the bedside, potentially altering teamwork and workflow in the operating theatre. This scoping review aimed to explore how factors affecting workflow as well as team members’ social and cognitive skills during robot-assisted surgery are reported in the literature. Methods: A systematic search was performed in the databases Medline, EMBASE, PsycINFO, and Web of Science. Reports were screened according to the Preferred Reporting Item for Systematic reviews and Meta-Analysis for Scoping Review guidelines. Inclusion criteria were robot-assisted surgery, multi-professional teams, and workflow, flow disruptions, or non-technical skills. Results: A total of 12,527 references were screened, and 24 articles were included in the review. Articles were heterogeneous in terms of aim, methods and focus. The studies concentrated on two main fields: flow disruptions and the categorization of their causes and incidences; and non-technical skills describing the challenges of communication and effects on situation awareness. Conclusion: Many studies focused on flow disruptions and found that communication, coordination, training, and equipment/technology were the most frequent causes. Another focus of studies was non-technical skills—primarily communication and situation awareness. Future studies could focus on how to prevent the most harmful flow disruptions and develop interventions for improving workflow.

BACKGROUND: Trainee surgeons would benefit from regular, formative assessments to ensure they learn the nontechnical aspects of surgical performance. Non-Technical Skills for Surgeons in Denmark (NOTSSdk) is a tool to assess surgeons' nontechnical skills (NTS) during an operation. The aims of this study were to explore which parts of NOTSSdk supervisors use to assess trainee surgeons' NTS, to determine the internal consistency reliability of NOTSSdk, and to estimate how many operations were needed to obtain reliable ratings of a trainee surgeon's NTS.METHODS: A total of 12 supervisors from 2 hospitals assessed 13 trainees in 48 procedures including laparoscopic cholecystectomies, inguinal hernia repairs, and laparoscopic appendectomies.RESULTS: NOTSSdk showed good internal consistency reliability (R(2) = 0.95). Supervisors used both categories and elements of the tool to provide assessments, although 2 elements of leadership ("supporting others" and "coping with pressure") were considered irrelevant in 27% to 31% of the cases. Assessments of 5 procedures were sufficient to gain reliable ratings (Generalizability coefficient > 0.80) of a trainee surgeon's NTS.CONCLUSION: As supervisors used the full tool, the internal consistency reliability was high and assessment of 5 procedures could be achieved in clinical practice, we suggest that NOTSSdk could be implemented as a formative assessment tool to facilitate the training of surgeons' NTS.

OBJECTIVE: This study aimed to explore the content of conversations, feedback style, and perceived usefulness of feedback to trainee surgeons when conversations were stimulated by a tool for assessing surgeons' non-technical skills.METHODS: Trainee surgeons and their supervisors used the Non-Technical Skills for Surgeons in Denmark tool to stimulate feedback conversations. Audio recordings of post-operation feedback conversations were collected. Trainees and supervisors provided questionnaire responses on the usefulness and comprehensiveness of the feedback. The feedback conversations were qualitatively analyzed for content and feedback style. Usefulness was investigated using a scale from 1 to 5 and written comments were qualitatively analyzed.RESULTS: Six trainees and six supervisors participated in eight feedback conversations. Eighty questionnaires (response rate 83 percent) were collected from 13 trainees and 12 supervisors. Conversations lasted median eight (2-15) minutes. Supervisors used the elements and categories in the tool to structure the content of the conversations. Supervisors tended to talk about the trainees' actions and their own frames rather than attempting to understand the trainees' perceptions. Supervisors and trainees welcomed the feedback opportunity and agreed that the conversations were useful and comprehensive.CONCLUSIONS: The content of the feedback conversations reflected the contents of the tool and the feedback was considered useful and comprehensive. However, supervisors talked primarily about their own frames, so in order for the feedback to reach its full potential, supervisors may benefit from training techniques to stimulate a deeper reflection among trainees.

Udgivelsesdato: 2009