title: Ambulatory movements, team dynamics and interactions during robot-assisted surgery.
abstract: To analyse ambulatory movements and team dynamics during robot-assisted surgery (RAS), and to investigate whether congestion of the physical space associated with robotic technology led to workflow challenges or predisposed to errors and adverse events.
  
  
  
  With institutional review board approval, we retrospectively reviewed 10 recorded robot-assisted radical prostatectomies in a single operating room (OR). The OR was divided into eight zones, and all movements were tracked and described in terms of start and end zones, duration, personnel and purpose. Movements were further classified into avoidable (can be eliminated/improved) and unavoidable (necessary for completion of the procedure).
  
  
  
  The mean operating time was 166 min, of which ambulation constituted 27 min (16%). A total of 2 896 ambulatory movements were identified (mean: 290 ambulatory movements/procedure). Most of the movements were procedure-related (31%), and were performed by the circulating nurse. We identified 11 main pathways in the OR; the heaviest traffic was between the circulating nurse zone, transit zone and supply-1 zone. A total of 50% of ambulatory movements were found to be avoidable.
  
  
  
  More than half of the movements during RAS can be eliminated with an improved OR setting. More studies are needed to design an evidence-based OR layout that enhances access, workflow and patient safety.
authors.affiliation: Applied Technology Laboratory for Advanced Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: Nabeeha
authors.initials: N
authors.lastname: Ahmad
authors.affiliation: Applied Technology Laboratory for Advanced Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA.|Department of Urology, Cairo University, Cairo, Egypt.
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Hussein
authors.affiliation: Applied Technology Laboratory for Advanced Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA.|Department of Industrial and Systems Engineering, University of Buffalo, Buffalo, NY, USA.
authors.forename: Lora
authors.initials: L
authors.lastname: Cavuoto
authors.affiliation: Applied Technology Laboratory for Advanced Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Sharif
authors.affiliation: Applied Technology Laboratory for Advanced Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: Jenna C
authors.initials: JC
authors.lastname: Allers
authors.affiliation: Department of Urology, University of Kobe, Kobe, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Hinata
authors.affiliation: Applied Technology Laboratory for Advanced Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: Basel
authors.initials: B
authors.lastname: Ahmad
authors.affiliation: Applied Technology Laboratory for Advanced Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: Justen D
authors.initials: JD
authors.lastname: Kozlowski
authors.affiliation: Applied Technology Laboratory for Advanced Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: Zishan
authors.initials: Z
authors.lastname: Hashmi
authors.affiliation: Applied Technology Laboratory for Advanced Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA.|Department of Industrial and Systems Engineering, University of Buffalo, Buffalo, NY, USA.
authors.forename: Ann
authors.initials: A
authors.lastname: Bisantz
authors.affiliation: Applied Technology Laboratory for Advanced Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: Khurshid A
authors.initials: KA
authors.lastname: Guru
mesh_terms: D006126:Group Processes; D006801:Humans; D019300:Medical Errors; D009068:Movement; D009873:Operating Rooms; D010348:Patient Care Team; D011468:Prostatectomy / Q000379:methods*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D057188:Workflow
keywords: disruption; error; layout; operating time; robot; robotic surgery; surgical flow