title: The Loud Surgeon Behind the Console: Understanding Team Activities During Robot-Assisted Surgery.
abstract: OBJECTIVE
  To design a data collection methodology to capture team activities during robot-assisted surgery (RAS) (team communications, surgical flow, and procedural interruptions), and use relevant disciplines of Industrial Engineering and Human Factors Engineering to uncover key issues impeding surgical flow and guide evidence-based strategic changes to enhance surgical performance and improve outcomes.
  
  
  METHODS
  Field study, to determine the feasibility of the proposed methodology.
  
  
  METHODS
  Recording the operating room (OR) environment during robot-assisted surgeries (RAS). The data collection system included recordings from the console and 3 aerial cameras, in addition to 8 lapel microphones (1 for each OR team member). Questionnaires on team familiarity and cognitive load were collected.
  
  
  METHODS
  In all, 37 patients and 89 OR staff members have consented to participate in the study.
  
  
  RESULTS
  Overall, 37 RAS procedures were recorded (130 console hours). A pilot procedure was evaluated in detail. We were able to characterize team communications in terms of flow, mode, topic, and form. Surgical flow was evaluated in terms of duration, location, personnel involved, purpose, and if movements were avoidable or not. Procedural interruptions were characterized according to their duration, cause, mode of communication, and personnel involved.
  
  
  CONCLUSIONS
  This methodology allowed for the capture of a wide variety of team activities during RAS that would serve as a solid platform to improve nontechnical aspects of RAS.
authors.affiliation: Department of Industrial and Systems Engineering, University at Buffalo, The State University of New York, Buffalo, New York; Advanced Technology Laboratory for Applied Surgery (A.T.L.A.S), Department of Urology, Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: Judith
authors.initials: J
authors.lastname: Tiferes
authors.affiliation: Advanced Technology Laboratory for Applied Surgery (A.T.L.A.S), Department of Urology, Roswell Park Cancer Institute, Buffalo, New York; Department of Urology, Cairo University, Cairo, Egypt.
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Hussein
authors.affiliation: Department of Industrial and Systems Engineering, University at Buffalo, The State University of New York, Buffalo, New York.
authors.forename: Ann
authors.initials: A
authors.lastname: Bisantz
authors.affiliation: Advanced Technology Laboratory for Applied Surgery (A.T.L.A.S), Department of Urology, Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: Justen D
authors.initials: JD
authors.lastname: Kozlowski
authors.affiliation: Advanced Technology Laboratory for Applied Surgery (A.T.L.A.S), Department of Urology, Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Sharif
authors.affiliation: Department of Industrial and Systems Engineering, University at Buffalo, The State University of New York, Buffalo, New York.
authors.forename: Nathalie M
authors.initials: NM
authors.lastname: Winder
authors.affiliation: Advanced Technology Laboratory for Applied Surgery (A.T.L.A.S), Department of Urology, Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: Nabeeha
authors.initials: N
authors.lastname: Ahmad
authors.affiliation: Advanced Technology Laboratory for Applied Surgery (A.T.L.A.S), Department of Urology, Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: Jenna
authors.initials: J
authors.lastname: Allers
authors.affiliation: Department of Industrial and Systems Engineering, University at Buffalo, The State University of New York, Buffalo, New York.
authors.forename: Lora
authors.initials: L
authors.lastname: Cavuoto
authors.affiliation: Advanced Technology Laboratory for Applied Surgery (A.T.L.A.S), Department of Urology, Roswell Park Cancer Institute, Buffalo, New York. Electronic address: Khurshid.guru@roswellpark.org.
authors.forename: Khurshid A
authors.initials: KA
authors.lastname: Guru
mesh_terms: D003142:Communication; D003625:Data Collection; D004526:Efficiency; D004777:Environment; D006804:Ergonomics; D005240:Feasibility Studies; D006801:Humans; D009873:Operating Rooms; D010348:Patient Care Team; D058996:Quality Improvement; D065287:Robotic Surgical Procedures; D011795:Surveys and Questionnaires; D013647:Task Performance and Analysis
keywords: Interpersonal and Communication Skills; Practice-Based Learning and Improvement; Systems-Based Practice; communication; flow; interruptions; nontechnical skills; robot-assisted surgery; team interactions