MSc Patient Safety and Human Clinical Factors, University of Edinburgh, Edinburgh, UK.
Department of General Surgery, Yeovil District Hospital, Yeovil, UK.
Surg Endosc. 2024 Apr;38(4):1758-1774. doi: 10.1007/s00464-024-10713-1. Epub 2024 Mar 11.
Undeniably, robotic-assisted surgery (RAS) has become very popular in recent decades, but it has introduced challenges to the workflow of the surgical team. Non-technical skills (NTS) have received less emphasis than technical skills in training and assessment. The systematic review aimed to update the evidence on the role of NTS in robotic surgery, specifically focusing on evaluating assessment tools and their utilisation in training and surgical education in robotic surgery.
A systematic literature search of PubMed, PsycINFO, MEDLINE, and EMBASE was conducted to identify primary articles on NTS in RAS. Messick's validity framework and the Modified Medical Education Research Study Quality Instrument were utilised to evaluate the quality of the validity evidence of the abstracted articles.
Seventeen studies were eligible for the final analysis. Communication, environmental factors, anticipation and teamwork were key NTS for RAS. Team-related factors such as ambient noise and chatter, inconveniences due to repeated requests during the procedure and constraints due to poor design of the operating room may harm patient safety during RAS. Three novel rater-based scoring systems and one sensor-based method for assessing NTS in RAS were identified. Anticipation by the team to predict and execute the next move before an explicit verbal command improved the surgeon's situational awareness.
This systematic review highlighted the paucity of reporting on non-technical skills in robotic surgery with only three bespoke objective assessment tools being identified. Communication, environmental factors, anticipation, and teamwork are the key non-technical skills reported in robotic surgery, and further research is required to investigate their benefits to improve patient safety during robotic surgery.
不可否认，机器人辅助手术（RAS）在近几十年来变得非常流行，但它给手术团队的工作流程带来了挑战。非技术技能（NTS）在培训和评估中的重视程度不如技术技能。本系统评价旨在更新关于 NTS 在机器人手术中的作用的证据，特别是评估评估工具及其在机器人手术培训和外科教育中的应用。
对 PubMed、PsycINFO、MEDLINE 和 EMBASE 进行系统文献检索，以确定关于 RAS 中 NTS 的原始文章。使用 Messick 的有效性框架和修改后的医学教育研究研究质量工具评估摘要文章的有效性证据质量。
有 17 项研究符合最终分析的条件。沟通、环境因素、预测和团队合作是 RAS 的关键 NTS。团队相关因素，如环境噪音和闲聊、由于手术过程中反复请求而带来的不便以及由于手术室设计不佳而导致的限制，可能会危害 RAS 期间的患者安全。确定了三种新的基于评分者的评分系统和一种用于评估 RAS 中 NTS 的基于传感器的方法。团队提前预测并在明确口头命令之前执行下一步动作，提高了外科医生的态势感知能力。
本系统评价强调了在机器人手术中报告非技术技能的不足，仅确定了三种定制的客观评估工具。沟通、环境因素、预测和团队合作是机器人手术中报告的关键非技术技能，需要进一步研究这些技能对提高机器人手术期间患者安全的益处。
