title: Quality of Communication in Robotic Surgery and Surgical Outcomes.
abstract: OBJECTIVE
  Robotic surgery has introduced unique challenges to surgical workflow. The association between quality of communication in robotic-assisted laparoscopic surgery and surgical outcomes was evaluated.
  
  
  METHODS
  After each gynecologic robotic surgery, the team members involved in the surgery completed a survey regarding the quality of communication. A composite quality-of-communication score was developed using principal component analysis. A higher composite quality-of-communication score signified poor communication. Objective parameters, such as operative time and estimated blood loss (EBL), were gathered from the patient's medical record and correlated with the composite quality-of-communication scores.
  
  
  RESULTS
  Forty robotic cases from March through May 2013 were included. Thirty-two participants including surgeons, circulating nurses, and surgical technicians participated in the study. A higher composite quality-of-communication score was associated with greater EBL (P = .010) and longer operative time (P = .045), after adjustment for body mass index, prior major abdominal surgery, and uterine weight. Specifically, for every 1-SD increase in the perceived lack of communication, there was an additional 51 mL EBL and a 31-min increase in operative time. The most common reasons reported for poor communication in the operating room were noise level (28/36, 78%) and console-to-bedside communication problems (23/36, 64%).
  
  
  CONCLUSIONS
  Our study demonstrates a significant association between poor intraoperative team communication and worse surgical outcomes in robotic gynecologic surgery. Employing strategies to decrease extraneous room noise, improve console-to-bedside communication and team training may have a positive impact on communication and related surgical outcomes.
authors: Division of Advanced Laparoscopy and Pelvic Pain, Department of Obstetrics and Gynecology. University of North Carolina, Chapel Hill, North Carolina, USA.
authors: Lauren
authors: L
authors: Schiff
authors: Division of Minimally Invasive Gynecology, Women's Health Services, Henry Ford Hospital, West Bloomfield, Michigan, USA.
authors: Ziv
authors: Z
authors: Tsafrir
authors: Division of Minimally Invasive Gynecology, Women's Health Services, Henry Ford Hospital, West Bloomfield, Michigan, USA.
authors: Joelle
authors: J
authors: Aoun
authors: Division of Biostatistics, Public Health Sciences, Henry Ford Health System, Detroit, Michigan, USA.
authors: Andrew
authors: A
authors: Taylor
authors: Division of Minimally Invasive Gynecology, Women's Health Services, Henry Ford Hospital, West Bloomfield, Michigan, USA.
authors: Evan
authors: E
authors: Theoharis
authors: Division of Minimally Invasive Gynecology, Women's Health Services, Henry Ford Hospital, West Bloomfield, Michigan, USA.
authors: David
authors: D
authors: Eisenstein
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D003142:Communication; D013509:Gynecologic Surgical Procedures / Q000592:standards*; D006801:Humans; D007400:Interprofessional Relations; D008875:Middle Aged; D061646:Operative Time; D010348:Patient Care Team / Q000592:standards*; D010865:Pilot Projects; D011183:Postoperative Complications / Q000453:epidemiology; D025341:Principal Component Analysis; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data; D065287:Robotic Surgical Procedures / Q000592:standards*
keywords: Communication; Gynecology; Robotic surgery; Surgical outcomes; Teamwork