Human Factors Integration in Robotic Surgery.

Objective: Using the example of robotic-assisted surgery (RAS), we explore the methodological and practical challenges of technology integration in surgery, provide examples of evidence-based improvements, and discuss the importance of systems engineering and clinical human factors research and practice.
Background: New operating room technologies offer potential benefits for patients and staff, yet also present challenges for physical, procedural, team, and organizational integration. Historically, RAS implementation has focused on establishing the technical skills of the surgeon on the console, and has not systematically addressed the new skills required for other team members, the use of the workspace, or the organizational changes.
Results: Human factors studies of robotic surgery have demonstrated not just the effects of these hidden complexities on people, teams, processes, and proximal outcomes, but also have been able to analyze and explain in detail why they happen and offer methods to address them. We review studies on workload, communication, workflow, workspace, and coordination in robotic surgery, and then discuss the potential for improvement that these studies suggest within the wider healthcare system.
Conclusion: There is a growing need to understand and develop approaches to safety and quality improvement through human-systems integration at the frontline of care.Precis: The introduction of robotic surgery has exposed under-acknowledged complexities of introducing complex technology into operating rooms. We explore the methodological and practical challenges, provide examples of evidence-based improvements, and discuss the implications for systems engineering and clinical human factors research and practice.
Competing Interests: KEY POINTSRobotic surgery requires new technical, team, and workspace organization skills for the surgeon, the operating room team, and the anesthesiologist while also requiring new training and staff development practices.Limited systems thinking in healthcare means it has taken nearly 20 years of robotic surgery use to study and reveal these effects, and there remains no formal acknowledgement or approach to addressing them.We outline approaches to teamwork training, task design, and workspace management that might successfully address this gap when implemented carefully into the wider clinical system.Recognizing the need for formal intervention approaches and human factors engineering is an important step towards improving the safety, efficiency, and efficacy of future surgical technologies.