As robotic procedures become more popular, surgeons and surgical teams need to be prepared for eventual breakdowns and malfunctions of the equipment, say University of Nebraska researchers who surveyed surgeons about what they do in cases of robotic failure.
More importantly, patients should be made aware of the surgeon's plans if the robot breaks down before or during the minimally invasive procedure. Depending on the situation, the surgeon can cancel and reschedule the procedure, convert to conventional laparoscopy, convert to an open procedure or finish with the robot and a work-around solution.
While surgical robot malfunctions are rare, they do happen less than 3% of the time. If the surgeon plans to convert to an open procedure, patients should be told about the possibility of waking up with a large sutured wound, rather than the small incision that they were expecting. "That's what the patient signed up for," says Chad LaGrange, MD, assistant professor and director of minimally invasive surgery at the University of Nebraska Medical Center, who co-authored an article based on the survey published this month in the Journal of Endourology.
Changing plans or canceling the procedure at the last minute can add stress to the patient's experience, especially since they've already taken a bowel prep, says Dr. LaGrange, who surveyed 176 urologists who perform robotic prostatectomy. Dr. LaGrange and colleagues found that 31% of the surgeons did not discuss with patients the risk of the robot not working and what they would do in such as case. "That's something that definitely should be discussed," says Dr. LaGrange.
Of the 100 surgeons who experienced breakdowns, 57% rescheduled, while 15% converted to a laparoscopic prostatectomy. The high rate of rescheduling is a sign of the surgeons' acceptance of the technology, says Dr. LaGrange.
In cases where the robot broke down before the urethrovesical anastomosis, 41% of the surgeons finished the case as an open procedure, while 32% finished laparoscopically. Malfunction of the robotic arms and cameras are the most common problems. Depending on the situation, the other surgeons docked to another robot, finished the case with fewer robotic arms or cameras, or swapped arms with another robot, according to the article.
In surgical facilities with robots, the perioperative team should be aware of the risk of breakdowns and discuss contingency plays. The team should also be mindful of how rescheduling or changing surgical plans affects patients, says Dr. LaGrange. "Before the patient is brought to the room, make sure that everything works."
Kent Steinriede
