Non-technical skills in robotic surgery and impact on near-miss events: a multi-center study
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Non‑technical skills in robotic surgery and impact on near‑miss events: a multi‑center study Anthony Manuguerra1,2 · Charles Mazeaud1 · Nicolas Hubert3 · Pascal Eschwège1,2,4 · Mathieu Roumiguié5 · Julia Salleron6 · Jacques Hubert1,7 Received: 13 May 2020 / Accepted: 14 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract 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 150 procedures in robotic surgery 20–150 procedures in robotic surgery or = 3 out of 5) in respectively 18 (69%), 15 (58%), and 13 procedures (50%). There was a statistically significant correlation between the environmental dimension and the skill dimension of the NTSRS score (correlation coefficient, r = 0.59, p = 0.002).
Near‑miss events For the 26 observed procedures, a median of 9 (quartiles: 7; 11) near-miss events per procedure was observed (Table 4); 38% (n = 10) of the procedures had more than nine nearmiss events and more than two grade 2 near-misses. The intra-class correlation coefficient for the number of grade 1 near-miss events was 0.87, 95% CI [0.75; 0.94] and 0.80 [0.61; 0.90] for grade 2 near-miss events. When there was fewer than 10 near-miss events, the number of grade 2 near misses was more than 1 in only one case. If there were more than 9 near-miss events, there was fewer than two grade 2 near-miss events in only one procedure.
Relationship between NTSRS scores and number of near‑miss events The number of near-miss events was strongly and negatively correlated with the NTSRS score (r = − 0.92, p
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