Non-technical skills in robotic surgery and impact on near-miss events: a multi-center study

Anthony Manuguerra (1, 2) , Charles Mazeaud (1) , Nicolas Hubert (3) , Pascal Eschwège (4, 1, 2) , Mathieu Roumiguié (5) , Julia Salleron (2) , Jacques Hubert (6, 1)

1 Service d'Urologie [CHRU Nancy]
2 UNICANCER/ICL - Institut de Cancérologie de Lorraine - Alexis Vautrin [Nancy]
3 Polyclinique de Gentilly
4 CRAN - Centre de Recherche en Automatique de Nancy
5 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
6 IADI - Imagerie Adaptative Diagnostique et Interventionnelle

Background: Robotic surgery requires a set of non-technical skills (NTS), because of the complex environment. We aim to study relationship between NTS and near-miss events in robotic surgery. Methods: This is an observational study in five French centers. Three robotic procedures were observed and filmed by one of expert trainers in NTS. They established and scored a non-technical skills in robotic surgery (NTSRS) score, that included eight items, each scored from 1 to 5, to assess the whole surgical teams. The surgical teams also self-assessed their work. The number of near-miss events was recorded and classified as minor, or major but no harm incidents, independently by two surgeons. Correlations were Spearman coefficients. Results: Of the 26 procedures included, 15 were prostatectomy (58%), 9 nephrectomy (35%), and 2 pyeloplasty (7.7%). Half of procedures (n = 13) were performed by surgeons with extensive RS experience (more than 150 procedures). Per procedure, there was a median (quartiles) of 9 (7; 11) near-miss events. There was 1 (0; 2) major near-miss events, with no harm. The median NTSRS score was 18 (14; 21), out of 40. The number of near-miss events was strongly correlated with the NTSRS score (r = − 0.92, p < 0.001) but was not correlated with the surgeon’s experience. The surgeons for fifteen (58%) procedures, and the bed-side surgeons for 11 (42%) procedures, felt that there was no need for an improvement in the quality of their NTS. None of the surgeons gave a negative self-evaluation for any procedure; in three procedures (12%), the bed-side surgeons self-assessed negatively, on ergonomics. Conclusion: Occurrence of near-miss events was reduced in teams managing NTS. Specific NTS surgical team training is essential for robotic surgery as it may have a significant impact on risk management.

Mots clés: Assessment; Live surgery; Near-miss events; Non-technical skills; Robotic surgery; Training

Domaines: Chirurgie

Anthony Manuguerra, Charles Mazeaud, Nicolas Hubert, Pascal Eschwège, Mathieu Roumiguié, et al.. Non-technical skills in robotic surgery and impact on near-miss events: a multi-center study. Surgical Endoscopy, 2021, 35 (9), pp.5062-5071. ⟨10.1007/s00464-020-07988-5⟩. ⟨hal-02994222⟩