Abstract:

Background:
The rapid introduction of technological innovations into the healthcare system has created new challenges for perioperative nurses. Especially, robotic-Assisted- Laparoscopic Surgery (RALS) has changed the physical and interpersonal context of the surgical team’s work and subsequent patient outcomes. Despite significant changes to the perioperative nursing practice, and workflow of Nurse Anesthetists, there is little research focusing on nurses’ education and experience and their challenges with RALS. The daVinci is the first surgical robot being approved by the Food and Drug Administration for a variety of surgeries and has been widely adopted in the United States and worldwide. In 2016, the number of daVinci systems in clinical use increased from 3,597 to 3,919, and approximately 753,000 RALS were performed in the United States. The introduction of any new technology, particularly such a complex surgical system, generates both benefits as well as unanticipated consequences. There is a lack of standardization of education and practice of surgeons and professional nurses involved in performing RALS.

Objective:
The purpose of this study was to explore the perioperative nurses and Nurse Anesthetists’ education, practice, and challenges with RALS. Perioperative nurses are responsible for calibrating the surgical robot before surgery; ensuring the integrity of the robotic supplies, handling the robotic surgical supplies before, during, and after the surgery; docking and undocking the robot; troubleshooting problems associated with the surgical robot; and preparing for complications and emergency conversions to open surgery. Nurse Anesthetists ensure patient hemodynamic status, while the patient remains in a steep Trendelenburg position accompanied by pneumoperitoneum, which sometimes lasts for several hours. There is an emphasis on the surgeons’ adoption of this new surgical technology and learning this new technique; however, there exists little concern about nurses’ education and training who work with the surgeons to perform these types of surgeries.

Design and Method:
The purpose of this qualitative study was to explore perioperative and Nurse Anesthetists’ experience and education with RALS. Seventeen participants including six preoperative and postoperative nurses, seven intraoperative nurses, and four CRNAs were interviewed. The interviews were conducted between 26 April–24 June 2018. All participants practiced in the United States and were from five different states and nine hospitals. Semi-structured interview questions guided data collection and thematic analysis was undertaken. Three major themes and two categories within each theme were identified: (a) surgical innovation: nurse perception and workflow;(b) interprofessional practice: teamwork and standards; and (c) outcome: patient outcomes and system outcomes.

Conclusions:
This study demonstrates the need for a universal standardized education and certification programs for those surgeons and professional nurses involved in robotic surgeries. The joint educational program should include modules, simulations, education on the components of the surgical robot, and the performance of mock surgeries.

Keywords:

Nursing education, robotic-assisted laparoscopic surgery, nursing practice, patient outcomes.