The pivotal role of the robotic nurse in the management of the robotic urologic surgical environment.

Introduction and Objectives: Robotic surgery has revolutionized urology. However, upfront costs, time investments and knowledge required to proficiently operate and maintain robotic equipment and supplies often make it advantageous to implement the role of dedicated robotic nurse (DN) teams. Herein, we aimed to investigate the impact of DN on operative times during robotic urological procedures. Materials and Methods: We retrospectively identified consecutive robotic uro‐oncological procedures performed at our institution from Jan to Oct 2023. The cohort was stratified based on the presence or absence of a DN team (DN vs no‐DN). The DN team was defined as having independently managed ≥100 robotic urological procedures. Endpoints were preoperative nursing time (pre‐NT), postoperative nursing time (post‐NT), surgeon operative time (surg‐OT), and total operative time (t‐OT). Continuous variables were compared using Student's t‐test. Subgroup analyses were conducted for specific procedures: robot‐assisted radical cystectomy (RARC), radical prostatectomy (RARP), partial nephrectomy (RAPN), and radical nephrectomy (RARN). Results: Overall, 421 procedures were included. The DN group exhibited shorter pre‐NT (13.5 vs 23.7, p < 0.001), post‐NT (12.2 vs. 15, p < 0.001), surg‐OT (117 vs. 136, p < 0.001), and t‐OT (143.2 vs. 174.9, p < 0.001) compared to the no‐DN group. Subgroup analysis revealed shorter pre‐NT in the DN group for all procedures: RARP (13.2 vs. 23.5, p < 0.001), RARC (16.4 vs. 29.2, p < 0.001), RARN (12.6 vs. 18.9, p < 0.001) and RAPN (12.7 vs. 20.8, p < 0.001). Conversely, DN group exhibited shorter post‐NT in RARP (12 vs. 15.8, p < 0.001) and RARN (12.4 vs. 15.3, p: 0.01), but not in RARC (13 vs. 15, p: 0.06) and RAPN (12.2 vs. 12.7, p: 0.4) subgroup. Similarly, DN group demonstrated shorter t‐OT in RARP (162.7 vs. 185.4, p < 0.001), but not in RARC (232.8 vs. 245, p: 0.44), RAPN (91.2 vs. 107.4, p: 0.35) and RARN (118.5 vs. 127.2, p: 0.4) subgroups. Finally, no differences in surg‐OT were recorded between the DN and non‐DN groups for any of the individual procedures (Table 1; Figure 1). 1 TABLE: Comparison of time per procedures between dedicated and non‐dedicated teams.: Variables mean (SD) RAPN group Variables mean (SD) RARP group Variables mean (SD) Overall procedures Dedicated nurse team (86) No dedicated nurse team (35) p ‐value Dedicated nurse team (86) No dedicated nurse team (35) p ‐value Dedicated nurse team (86) No dedicated nurse team (35) p ‐value Preoperative nursing time 12.7 (±2.7) 20.8 (±5.9) <0. 001 Preoperative nursing time 13.2 (±3.3) 23.5 (±9.8) <0. 001 Preoperative nursing time 13.5 (±3.6) 23.7 (±9.7) <0. 001 Postoperative nursing time 12.2 (±3.7) 12.7 (±3.4) 0.4 Postoperative nursing time 12 (±4.1) 15.8 (±6.3) <0.001 Postoperative nursing time 12.2 (±3.9) 15 (±5.6) <0.001 Operative time 66.2 (±29.1) 73.8 (±44.4) 0.3 Operative time 137.5 (±37.2) 146.1 (±41.1) 0.18 Operative time 117 (±68) 136 (±68.8) <0. 001 Total operation time 91.2 (±30.2) 107.4 (±46.1) 0.35 Total operation time 162.7 (±37.8) 185.4 (±39.6) <0. 001 Total operation time 143.2 (±69) 174.9 (±72,1) <0. 001 Variables mean (SD) RARC group Variables mean (SD) RARN group Dedicated nurse team (86) No dedicated nurse team (35) p ‐value Dedicated nurse team (86) No dedicated nurse team (35) p ‐value Preoperative nursing time 16.4 (±4.8) 29.2 (±8.9) <0. 001 Preoperative nursing time 12.6 (±2.8) 18.9 (±4.7) <0. 001 Postoperative nursing time 13 (±3.5) 15 (±4.5) 0.06 Postoperative nursing time 12.4 (±3.9) 15.3 (±5.7) 0.01 Operative time 203.4 (±68.5) 200.8 (±69.7) 0.86 Operative time 93.5 (±38.7) 93 (±42.2) 0.9 Total operation time 232.8 (±66.4) 245 (±72.6) 0.44 Total operation time 118.5 (±38.9) 127.2 (±43.1) 0.4 Note: Bold indicates significant value. 1 FIGURE: Comparison of preoperative nursing time DN Team versus NoDN Team. Conclusions: Our study suggests that the implementation of a dedicated robotic nursing team can lead to substantial reductions in overall operative time. This benefit is primarily attributed to shorter preoperative nursing times, highlighting the crucial role of the robotic nurse in optimizing the robotic surgical environment. [ABSTRACT FROM AUTHOR]