Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstrasse 1, 80336, Munich, Germany.
Institute for Medical Information Processing, Biometry and Epidemiology (IBE), LMU Munich, Munich, Germany.
Surg Endosc. 2022 Mar;36(3):1916-1926. doi: 10.1007/s00464-021-08474-2. Epub 2021 Apr 12.
Non-technical skills (NTS) are essential for safe surgical practice as they impact workflow and patient outcomes. Observational tools to measure operating room (OR) teams' NTS have been introduced. However, there are none that account for the specific teamwork challenges introduced by robotic-assisted surgery (RAS). We set out to develop and content-validate a tool to assess multidisciplinary NTS in RAS.
Stepwise, multi-method procedure. Observations in different surgical departments and a scoping literature review were first used to compile a set of RAS-specific teamwork behaviours. This list was refined and expert validated using a Delphi consensus approach consisting of qualitative interviews and a quantitative survey. Then, RAS-specific behaviours were merged with a well-established assessment tool on OR teamwork (NOTECHS II). Finally, the new tool-RAS-NOTECHS-was applied in standardized observations of real-world procedures to test its reliability (inter-rater agreement via intra-class correlations).
Our scoping review revealed 5242 articles, of which 21 were included based on pre-established inclusion criteria. We elicited 16 RAS-specific behaviours from the literature base. These were synthesized with further 18 behavioural markers (obtained from 12 OR-observations) into a list of 26 behavioural markers. This list was reviewed by seven RAS experts and condensed to 15 expert-validated RAS-specific behavioural markers which were then merged into NOTECHS II. For five observations of urologic RAS procedures (duration: 13 h and 41 min), inter-rater agreement for identification of behavioural markers was strong. Agreement of RAS-NOTECHS scores indicated moderate to strong agreement.
RAS-NOTECHS is the first observational tool for multidisciplinary NTS in RAS. In preliminary application, it has been shown to be reliable. Since RAS is rapidly increasing and challenges for effective and safe teamwork remain at the forefront of quality and safety of surgical care, RAS-NOTECHS may contribute to training and improvement efforts in technology-facilitated surgeries.
非技术技能（NTS）对于安全的外科实践至关重要，因为它们会影响工作流程和患者的结果。已经引入了用于测量手术室（OR）团队 NTS 的观察工具。但是，还没有一种工具可以说明机器人辅助手术（RAS）带来的特定团队合作挑战。我们着手开发并对内容进行验证，以开发一种用于评估 RAS 中多学科 NTS 的工具。
逐步，多方法程序。首先在不同的外科部门进行观察，并进行范围广泛的文献复习，以汇编一套特定于 RAS 的团队合作行为。然后使用包含定性访谈和定量调查的 Delphi 共识方法对该清单进行了细化和专家验证。然后，将 RAS 特定行为与经过良好验证的 OR 团队协作评估工具（NOTECHS II）合并。最后，在真实程序的标准化观察中应用新工具-RAS-NOTECHS-以测试其可靠性（通过组内相关系数进行的评分者间一致性）。
我们的范围综述共显示了 5242 篇文章，其中根据预先确定的纳入标准纳入了 21 篇文章。我们从文献中提取了 16 种 RAS 特定行为。然后，将这些行为与其他 18 种行为标记（从 12 个 OR 观察中获得）综合在一起，形成了 26 种行为标记的列表。该列表由七名 RAS 专家审查，并压缩为 15 个经过专家验证的 RAS 特定行为标记，然后将其合并到 NOTECHS II 中。在对五例泌尿科 RAS 手术（持续时间：13 小时 41 分钟）进行观察时，对行为标记的识别具有很强的评分者间一致性。RAS-NOTECHS 评分的一致性表明了中度至高度的一致性。
RAS-NOTECHS 是第一个用于 RAS 中多学科 NTS 的观察工具。在初步应用中，它已被证明是可靠的。由于 RAS 的发展迅速，而有效的和安全的团队合作挑战仍然是手术护理质量和安全的最前沿，因此 RAS-NOTECHS 可能有助于在技术辅助手术中进行培训和改进工作。
