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Effects of Flow Disruptions on Mental Workload and Surgical Performance in Robotic-Assisted Surgery

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Abstract

Background

Robotic systems introduced new surgical and technical demands. Surgical flow disruptions are critical for maintaining operating room (OR) teamwork and patient safety. Specifically for robotic surgery, effects of intra-operative disruptive events for OR professionals’ workload, stress, and performance have not been investigated yet. This study aimed to identify flow disruptions and assess their association with mental workload and performance during robotic-assisted surgery.

Methods

Structured expert-observations to identify different disruption types during 40 robotic-assisted radical prostatectomies were conducted. Additionally, 216 postoperative reports on mental workload (mental demands, situational stress, and distractions) and performance of all OR professionals were collected.

Results

On average 15.8 flow disruptions per hour were observed with the highest rate after abdominal insufflation and before console time. People entering the OR caused most flow disruptions. Disruptions due to equipment showed the highest severity of interruption. Workload significantly correlated with severity of disruptions due to coordination and communication.

Conclusions

Flow disruptions occur frequently and are associated with increased workload. Therefore, strategies are needed to manage disruptions to maintain OR teamwork and safety during robotic-assisted surgery.

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Acknowledgements

We thank all surgeons, nurses and anesthetists for their participation.

Funding

The study was supported by the Munich Centre for Health Sciences (MC-Health) and the Bavarian Research Alliance (BAYFOR).

Author information

Authors and Affiliations

  1. Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-University Munich, Munich, Germany

    Jeannette Weber & Matthias Weigl

  2. Institute for Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University Munich, Munich, Germany

    Jeannette Weber

  3. Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, USA

    Ken Catchpole

  4. Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany

    Armin J. Becker & Boris Schlenker

  5. Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Heinrich-Heine-University Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany

    Jeannette Weber

Authors
  1. Jeannette Weber
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  2. Ken Catchpole
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  3. Armin J. Becker
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Corresponding author

Correspondence to Jeannette Weber.

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Weber, J., Catchpole, K., Becker, A.J. et al. Effects of Flow Disruptions on Mental Workload and Surgical Performance in Robotic-Assisted Surgery. World J Surg 42, 3599–3607 (2018). https://doi.org/10.1007/s00268-018-4689-4

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  • DOI: https://doi.org/10.1007/s00268-018-4689-4

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