Grover Karan, Mowoh Daniel Praise, Chatha Hamza Nasir, Mallidi Ajitha, Sarvepalli Shravan, Peery Curtis, Galvani Carlos, Havaleshko Dmytro, Taggar Amit, Khaitan Leena, Abbas Mujjahid
Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Lakeside 7, Cleveland, OH, 44106-5047, USA.
Shifa College of Medicine, Islamabad, Pakistan.
Surg Endosc. 2023 Dec;37(12):9523-9532. doi: 10.1007/s00464-023-10354-w. Epub 2023 Sep 13.
The safe and effective performance of a robotic roux-en-y gastric bypass (RRNY) requires the application of a complex body of knowledge and skills. This qualitative study aims to: (1) define the tasks, subtasks, decision points, and pitfalls in a RRNY; (2) create a framework upon which training and objective evaluation of a RRNY can be based.
Hierarchical and cognitive task analyses for a RRNY were performed using semi-structured interviews of expert bariatric surgeons to describe the thoughts and behaviors that exemplify optimal performance. Verbal data was recorded, transcribed verbatim, supplemented with literary and video resources, coded, and thematically analyzed.
A conceptual framework was synthesized based on three book chapters, three articles, eight online videos, nine field observations, and interviews of four subject matter experts (SME). At the time of the interview, SME had practiced a median of 12.5 years and had completed a median of 424 RRNY cases. They estimated the number of RRNY to achieve competence and expertise were 25 cases and 237.5 cases, respectively. After four rounds of inductive analysis, 83 subtasks, 75 potential errors, 60 technical tips, and 15 decision points were identified and categorized into eight major procedural steps (pre-procedure preparation, abdominal entry & port placement, gastric pouch creation, omega loop creation, gastrojejunal anastomosis, jejunojejunal anastomosis, closure of mesenteric defects, leak test & port closure). Nine cognitive behaviors were elucidated (respect for patient-specific factors, tactical modification, adherence to core surgical principles, task completion, judicious technique & instrument selection, visuospatial awareness, team-based communication, anticipation & forward planning, finessed tissue handling).
This study defines the key elements that formed the basis of a conceptual framework used by expert bariatric surgeons to perform the RRNY safely and effectively. This framework has the potential to serve as foundational tool for training novices.
机器人辅助胃旁路手术（RRNY）的安全有效实施需要运用一系列复杂的知识和技能。本定性研究旨在：（1）明确RRNY中的任务、子任务、决策点和陷阱；（2）创建一个可用于RRNY培训和客观评估的框架。
通过对肥胖症外科专家进行半结构化访谈，对RRNY进行分层和认知任务分析，以描述体现最佳手术表现的思维和行为。记录言语数据，逐字转录，辅以文献和视频资源，进行编码和主题分析。
基于三本书章、三篇文章、八个在线视频、九次实地观察以及对四位主题专家（SME）的访谈，综合形成了一个概念框架。在访谈时，SME的中位从业年限为12.5年，RRNY手术的中位完成例数为424例。他们估计达到胜任水平和专业水平所需的RRNY手术例数分别为25例和237.5例。经过四轮归纳分析，确定了83个子任务、75个潜在错误、60个技术要点和15个决策点，并将其归类为八个主要手术步骤（术前准备、腹部切开与端口置入、胃囊创建、欧米伽袢创建、胃空肠吻合、空肠空肠吻合、肠系膜缺损闭合、漏液测试与端口闭合）。阐明了九种认知行为（尊重患者特异性因素、策略调整、遵循核心手术原则、任务完成、明智的技术和器械选择、视觉空间意识、团队沟通、预判与前瞻性规划、精细的组织处理）。
本研究明确了构成肥胖症外科专家安全有效实施RRNY的概念框架基础的关键要素。该框架有可能成为培训新手的基础工具。
