The Route To Patient Safety In Robotic Surgery

The introduction of a new technology in a consolidated field has the potential to disrupt usual practices and create a fertile ground for errors. An example is robotic surgery that is now used in most surgical specialties, pushed by technology developers and enthusiastic surgeons. To analyze the potential impact of robotic surgery on patient safety, a consortium of major European Universities started the project SAFROS whose findings are summarized and further elaborated in the three parts of this book. Part one describes safety in complex systems such as surgery, how this may disrupt the traditional surgical workflow, how safety can be monitored, and the research questions that must be posed. Part two of the book describes the main findings of this research, by identifying the risks of robotic surgery and by describing where its ancillary technologies may fail. This part addresses features and evaluation of anatomic imaging and modeling, actions in the operating room, robot monitoring and control, operator interface, and surgical training. Part three of the book draws the conclusions and offers suggestions on how to limit the risks of medical errors. One possible approach is to use automation to monitor and execute parts of an intervention, thus suggesting that robotics and artificial intelligence will be major elements of the operating room of the future.

The first edition of Robotic Surgery was written only a decade after the introduction of robotic technology. It was the first comprehensive robotic surgery reference and represented the early pioneering look ahead to the future of surgery. Building upon its success, this successor edition serves as a complete multi-specialty sourcebook for robotic surgery. It seeks to explore an in-depth look into surgical robotics and remote technologies leading to the goal of achieving the benefits of traditional surgery with the least disruption to the normal functions of the human body. Written by experts in the field, chapters cover the fundamental principles of robotic surgery and provide clear instruction on their clinical application and long term results. Most notably, one chapter on “The Blueprint for the Establishment of a Successful Robotic Surgery Program: Lessons from Admiral Hymen R. Rickover and the Nuclear Navy” outlines the many valuable lessons from the transformative change which was brought about by the introduction of nuclear technology into the conventional navy with Safety as the singular goal of the change process. Robotics represents a monumental triumph of surgical technology. Undoubtedly, the safety of the patient will be the ultimate determinant of its success. The second edition of Robotic Surgery aims to erase the artificial boundaries of specialization based on regional anatomy and serves as a comprehensive multispecialty reference for all robot surgeons. It allows them to contemplate crossing boundaries which are historically defined by traditional open surgery.

This book focuses exclusively on the surgical patient and on the perioperative environment with its unique socio-technical and cultural issues. It covers preoperative, intraoperative, and postoperative processes and decision making and explores both sharp-end and latent factors contributing to harm and poor quality outcomes. It is intended to be a resource for all healthcare practitioners that interact with the surgical patient. This book provides a framework for understanding and addressing many of the organizational, technical, and cultural aspects of care to one of the most vulnerable patients in the system, the surgical patient. The first section presents foundational principles of safety science and related social science. The second exposes barriers to achieving optimal surgical outcomes and details the various errors and events that occur in the perioperative environment. The third section contains prescriptive and proactive tools and ways to eliminate errors and harm. The final section focuses on developing continuous quality improvement programs with an emphasis on safety and reliability. Surgical Patient Care: Improving Safety, Quality and Value targets an international audience which includes all hospital, ambulatory and clinic-based operating room personnel as well as healthcare administrators and managers, directors of risk management and patient safety, health services researchers, and individuals in higher education in the health professions. It is intended to provide both fundamental knowledge and practical information for those at the front line of patient care. The increasing interest in patient safety worldwide makes this a timely global topic. As such, the content is written for an international audience and contains materials from leading international authors who have implemented many successful programs.

In this thoroughly revised second edition of the frequently downloaded manual, The SAGES Manual of Quality, Outcomes, and Patient Safety. A panel of experts update and expand their survey of the many factors that influence quality in the world of surgery, surgical outcomes, and threats to patient safety. Among the highlights include a section devoted to threats to quality and outcomes and safety, such as surgeon wellness and burnout, disruptive behavior, second victims, the surgeon with declining skills, and maintaining quality in the setting of a crisis. Another all-new section focuses on surgical controversies, such as whether or not to use robotic surgical technology and whether or not it influences surgical outcomes; whether or not routine cholangiography reduces the common bile duct injury rate; whether or not having a consistent operating room team influences surgical outcomes, and whether a conflict of interest truly influences surgical quality. Further, this manual updates chapters on surgical simulation, teamwork and team training, teleproctoring, mentoring, and error analysis. State-of-the-art and readily accessible, The SAGES Manual of Quality, Outcomes, and Patient Safety, Second Edition will offer physicians strategies to maintain surgical quality in a rapidly changing practice environment the tools they require to succeed.

Robotics began as a science fiction creation which has become quite real, first in assembly line operations such as automobile manufacturing, airplane construction etc. They have now reached such areas as the ever-multiplying - medical field. Robotic surgery is now becoming highly practised in open heart, lung, and other forms of surgery. This book covers the developing stages of robotic surgery and its expectations in the medical field.

Specific injuries due to poor positioning seen in robotic pelvic surgery include slips, compartment syndrome, facial oedema, injuries on pressure points, and accidental injuries caused by the robotic arms. The use of the vacuum bean-bag positioner, L-bar against the patient’s face, and inflated gloves for hand support are simple and effective techniques and should be included in the standard operating policies for robotic surgery. We recommend use of the “L” shaped safety bar against the patient’s face to ensure protection against accidental injuries caused by the robotic arms. The anti-slip bean-bag mattress is efficient to prevent slipping; it conforms to the shape of the body for stable positioning and allows extremities to lie in a natural position. Protection of pressure points of hands and elbows can be done with inflated medical gloves placed in the patient’s hands. Surgeons, anaesthetists and theatre teams are together responsible for ensuring that safety measures are in place to reduce the risk of these complications.

Written in readable format and rich with clinical cases, this book systematically introduces surgical nursing during robotic surgery. The first part introduces the history of robotic surgery, operating room management, quality control of robotic surgical nursing, management of safety, infection, and anaesthesia. The second part introduces key points of nursing during robotic surgery in urology, general surgery, gynaecology, heart, chest and otorhinolaryngology. It will be a helpful reference for practitioners those in the process of implanting or about to implant robotic surgery.

In general, surgeons strive to achieve excellent results and ideal patient outcomes, however, this noble task is frequently failed. For patients, surgical complications are analogous to “friendly fire” in wartime. Both scenarios imply that harm is unintentionally done by somebody whose aim was to help. Interestingly, adverse events resulting from surgical interventions are more frequently related to system errors and a communication breakdown among providers, rather than to the imminent threat of the surgical blade “gone wrong”. Patient Safety in Surgery aims to increase the safety and quality of care for patients undergoing surgical procedures in all fields of surgery. Patient Safety in Surgery, covers all aspects related to patient safety in surgery, including pertinent issues of interest to surgeons, medical trainees (students, residents, and fellows), nurses, anaesthesiologists, patients, patient families, advocacy groups, and medicolegal experts.​ ​​