Many robotic operations involve positioning of patients in angles that may not be well studied. Indeed, patient positioning in extended robotic operations is of particular concern in regards to patient safety. Furthermore, extended cases can put the patient at increased risk for position-related patient complications such as peri-operative peripheral nerve injury and rhabdomyolysis. Not only do they exacerbate surgeon fatigue, but long cases also complicate nursing and anesthetic care. These prolonged operations can be a challenge on many fronts. Additionally, as complex operations are often embraced with robotics, longer operating room (OR) times are common in the early experience. Īs most practicing surgeons have not had extensive training in robotic surgery, the learning curve may be heterogeneous. Indeed, robotic prostatectomy is currently estimated to be the most used method for radical prostatectomy in the United States and robotic surgeries are being more frequently utilized in general and thoracic surgeries. After initial applications in gynecologic and urologic surgeries, robotic operations are now becoming more common. Improved dexterity in narrow spaces and faster patient recovery are just some of the advantages cited in favor of adopting this new approach. Robotic surgery has become an increasingly adopted technology. A standardized surgical checklist, conducted three to four hours after the start of surgery, may enhance perioperative patient safety and quality of care. As robotic surgery is increasingly utilized, operations with long surgical times may become more common due to increased case complexity and surgeons overcoming the learning curve. Key elements of the checklist were designed to coordinate operative staff in verifying patient safety while addressing the unique concerns within each specialty. These cases also raise concerns for surgical, anesthesia, and nursing staff which are less common in shorter, non-robotic operations. Extended operative times during robotic surgery increase patient risk for position-related complications and other adverse events. A surgical checklist was developed with the goal of addressing these issues and maximizing patient safety. A review of the literature was performed to identify the most common complications of robotic surgeries with extended operative times. We propose a surgical checklist, to be completed during a second “time-out”, aimed at reducing peri-operative complications and addressing obstacles presented by lengthy robotic surgeries. Robotic surgeries of long duration are associated with both increased risks to patients as well as distinct challenges for care providers.
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