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1.
Anticancer Res ; 39(11): 6339-6346, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31704865

RESUMO

BACKGROUND/AIM: To evaluate the chronological changes in health-related quality of life and treatment satisfaction after robot-assisted radical prostatectomy (RARP). PATIENTS AND METHODS: A total of 196 patients were included, and treatment satisfaction was evaluated using the Expanded Prostate Cancer Index Composite (EPIC) score before and at 1, 3, 6, and 12 months after RARP. RESULTS: At 12 months after RARP, 64.8% of patients were satisfied. On the contrary, 4.6% of patients were dissatisfied at 12 months after RARP. In a multivariate analysis, only urinary bother of EPIC was significantly associated with satisfaction at 12 months after RARP (p=0.025, odds ratio=1.029). CONCLUSION: Treatment satisfaction with RARP was generally acceptable from 1 to 12 months after surgery and did not change over time. Urinary bother was associated with satisfaction at 12 months after RARP. Compared with the objective 24-hour pad test, questionnaires answered subjectively were more associated with satisfaction.


Assuntos
Satisfação do Paciente/estatística & dados numéricos , Prostatectomia/psicologia , Qualidade de Vida , Procedimentos Cirúrgicos Robóticos/psicologia , Idoso , Disfunção Erétil/etiologia , Disfunção Erétil/psicologia , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/psicologia , Antígeno Prostático Específico/sangue , Prostatectomia/efeitos adversos , Prostatectomia/métodos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Terapia de Salvação/métodos , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do Tratamento , Incontinência Urinária/etiologia , Incontinência Urinária/psicologia
2.
Medicine (Baltimore) ; 98(23): e15974, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31169730

RESUMO

BACKGROUND: Hysterectomy for benign gynecologic diseases, especially dysfunctional uterine bleeding, is one of the most common gynecologic interventions. The uterus can be removed using abdominal, vaginal, laparoscopic, or robotic-assisted laparoscopic hysterectomy. In a robotic-assisted procedure, the surgeon directs the robot while seated at a console in the operating room. This differs from laparoscopic hysterectomy because a "robot" performs the operation, while the surgeon watches a monitor. This systematic review will compare quality of life (QOL) in patients who undergo total robotic-assisted laparoscopic hysterectomy for benign indications and those who undergo conventional laparoscopic surgery. METHODS: We will perform a systematic review according to the Cochrane Methodology for randomized controlled trials. The review will include studies reporting use of QOL metrics to assess patients who undergo total hysterectomy for benign indications using robotic-assisted technique or conventional laparoscopic surgery. QOL will be the primary outcome and will be measured using validated instruments. An overall search strategy will be developed and adapted for Embase, MEDLINE, LILACS, and CENTRAL databases. Two reviewers will independently select the eligible studies, assess the risk of bias, and extract the data from included studies. Similar outcomes measured in at least 2 trials will be plotted in the meta-analysis using Review Manager 5.3. The quality of evidence will be determined using the GRADE approach. RESULTS: This systematic review is designed to provide high quality evidence on QOL in patients undergoing total hysterectomy for benign indications using either robotic-assisted or conventional laparoscopic surgery. CONCLUSION: It is expected that high-quality evidence on QOL can be used to guide decision-making by institutions and clinicians to improve health care; the evidence can also be used in future studies. PROSPERO REGISTRATION NUMBER: PROSPERO CRD 42019129913.


Assuntos
Histerectomia/psicologia , Laparoscopia/psicologia , Qualidade de Vida/psicologia , Procedimentos Cirúrgicos Robóticos/psicologia , Feminino , Humanos , Histerectomia/métodos , Laparoscopia/métodos , Período Pós-Operatório , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Procedimentos Cirúrgicos Robóticos/métodos , Revisão Sistemática como Assunto , Resultado do Tratamento
3.
PLoS One ; 14(3): e0213840, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30870503

RESUMO

BACKGROUND: The use of robotic-assisted surgery (RAS) is becoming increasingly prevalent across a range of surgical specialties within public hospitals around Australia. As a result, it is critical that organisations consider workplace factors such as staff knowledge, attitudes and behaviours prior to the implementation of such new technology. This study aimed to describe the knowledge and attitudes of operating theatre staff from a large public tertiary referral hospital prior to the commencement of an RAS program. METHODS: A cross-sectional survey of nursing, medical and support staff working in the operating theatre complex of a large public tertiary referral hospital was completed over a one-week period in June 2016. A 23-item questionnaire was utilised for data collection. RESULTS: 164 (66%) theatre staff returned the surveys and were included in this study. The majority of medical staff reported being knowledgeable about RAS, whilst the majority of nursing and support staff did not. Overall the theatre staff were neutral about the potential benefits of RAS to patients. The majority of medical staff believed the implementation of RAS will increase the value of staff roles and job satisfaction, while nursing and support staff were uncertain about these benefits. All three staff groups were concerned about the impact of an RAS program on Workplace Health and Safety, and care and handling. CONCLUSION: Operating theatre staff presented different knowledge and attitudes prior to the introduction of RAS. Whilst theatre staff were more favourable towards RAS than negative, they largely reserved their judgement about the new system prior to their own experiences. Collectively, these findings should be taken into consideration for training and support strategies prior to the implementation of a RAS program.


Assuntos
Atitude do Pessoal de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Satisfação no Emprego , Corpo Clínico/psicologia , Setor Público/normas , Procedimentos Cirúrgicos Robóticos/psicologia , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Salas Cirúrgicas , Inquéritos e Questionários , Local de Trabalho
4.
Asian J Surg ; 42(4): 543-550, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30704965

RESUMO

BACKGROUND: Robotic hepatectomy has been accepted as an alternative for patients needing surgery. However, few reports addressed the patient-reported outcomes and long-term quality of life (QoL) of patients having undergone robotic liver surgery. METHODS: This study presented the QoL and cost-effectiveness associated with robotic and open hepatectomy by performing a comparative survey using two standardized questionnaires (Short Form-36 and Gastrointestinal Quality of Life Index). RESULTS: One hundred patients completed the study. The robotic group tended to experienced longer operation time but shorter length of hospital stay compared to open group. Moreover, the robotic group had faster return to daily activities, less need of patient-controlled anesthesia, and less wound-related complaints in long-term follow-up. The robotic group incurred higher peri-operative expenses; however, the cost of inpatient care was lower. CONCLUSIONS: Our study suggested that robotic hepatectomy provided good post-operative QoL and recovery of daily activity. However, efforts for lowering the financial burden of medical care by reducing the cost of robotic surgery is necessary for further application.


Assuntos
Redução de Custos , Hepatectomia/economia , Fígado/cirurgia , Satisfação do Paciente , Pacientes/psicologia , Qualidade de Vida , Procedimentos Cirúrgicos Robóticos/economia , Idoso , Analgesia Controlada pelo Paciente/estatística & dados numéricos , Efeitos Psicossociais da Doença , Feminino , Seguimentos , Hepatectomia/métodos , Hepatectomia/psicologia , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Recuperação de Função Fisiológica , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/psicologia , Fatores de Tempo , Resultado do Tratamento
5.
J Robot Surg ; 13(1): 155-158, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30099663

RESUMO

Acquisition of robotic surgical skills by surgical residents is usually hindered by time pressure and financial imperatives. Robotic simulation training offers an attractive solution because it allows residents to learn in a safe, controlled, and standardized environment. We aimed to determine the confidence levels of senior surgical residents with the robotic platform, and how those levels were affected by simulation training. Twenty senior residents participated in a simulation course using perfused porcine tissue blocks to perform the following robotic procedures: Nissen fundoplication, Heller myotomy, sleeve gastrectomy, colectomy, and lobectomy. Procedural steps evaluated included port placements, docking process, suturing, using energy devices, and using staplers. Mean baseline confidence levels were low for all the surgical steps analyzed, and all these values significantly increased after the 3-day robotic training in the simulation center. A standardized formal robotic simulation program with realistic hands-on training should be incorporated in the general surgery residency curriculum.


Assuntos
Competência Clínica , Educação de Pós-Graduação em Medicina/métodos , Cirurgia Geral/educação , Internato e Residência , Procedimentos Cirúrgicos Robóticos/educação , Procedimentos Cirúrgicos Robóticos/psicologia , Treinamento por Simulação/métodos , Estudantes de Medicina/psicologia , Animais , Currículo , Humanos , Procedimentos Cirúrgicos Robóticos/métodos , Suínos
6.
BJU Int ; 122(1): 99-105, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29388382

RESUMO

OBJECTIVE: To investigate and analyse the different ways surgeons communicate with bedside assistants during robot-assisted surgery (RAS). METHODS: We retrospectively reviewed video and audio recordings of 26 RAS procedures (23 prostatectomies and three cystectomies). Three cameras and eight lapel microphones were used to record the operating theatre environment. We identified five common tasks and categorized them into 'specific', 'non-specific' and 'unclear' categories. We also determined the frequency, time to execute the task, inconveniences and acknowledgements associated with each category. The most efficient category was the one that took the shortest duration to accomplish and was associated with the fewest inconveniences. RESULTS: A total of 1 000 requests were made by three surgeons for six bedside assistants by three surgeons. The five identified tasks were: instrument change; clipping; suction; irrigation; and retraction. For instrument change, non-specific requests were the most frequent compared with the other categories (77% vs 18% vs 5%; P < 0.001). For suction, specific requests were the most frequently used of the three categories (73% vs 27% vs 0%; P < 0.001) and this task was associated with the fewest inconveniences (38% vs 62%; P = 0.01). For clipping, irrigation and retraction, both specific and non-specific requests were similar in terms of their frequency, action time and inconveniences. Comparing complete vs incomplete requests, incomplete requests had significantly shorter median action time (5 vs 8 s; P < 0.001) but did not significantly differ in terms of inconveniences and acknowledgement. CONCLUSION: To our knowledge, this is the first study to provide a detailed analysis of communication during RAS. It lays a foundation for standardized taxonomy to improve communication, surgical efficiency and patient safety.


Assuntos
Comunicação , Procedimentos Cirúrgicos Robóticos/psicologia , Classificação , Compreensão , Cistectomia/psicologia , Humanos , Relações Interprofissionais , Equipe de Assistência ao Paciente , Segurança do Paciente , Prostatectomia/psicologia , Estudos Retrospectivos , Terminologia como Assunto
7.
JSLS ; 22(1)2018.
Artigo em Inglês | MEDLINE | ID: mdl-29472757

RESUMO

Background and Objectives: The learning curve for achieving desirable perioperative outcomes in robot-assisted partial nephrectomy (RAPN) has not been well studied. Information is available regarding "trifecta" outcomes of no complications, no positive margins, warm ischemia time (WIT) of ≤25 minutes, and a ≤15% decrease in postoperative glomerular filtration rate (GFR). This study was conducted to assess the impact of the learning curve on surgical outcomes in patients undergoing RAPN. Methods: We reviewed 131 consecutive patients who underwent RAPN by a single, fellowship-trained surgeon from October 2007 through June 2015. Patients were divided into 4 subgroups, and mean perioperative values were compared. The learning curve was evaluated as the time it took the surgeon to attain a trifecta outcome. Results: Means for the RENAL Nephrometry Score, procedure length, WIT, and estimated blood loss (EBL) were 5.3 ± 1.2, 172.1 ± 43.5 minutes, 22.7 ± 7.0 minutes, and 267.2 ± 341.8 mL, respectively. Significance was noted for differences in WIT (P = .50), postoperative creatinine (P = .006), postoperative estimated (e)GFR (P = .40), and percentage change in creatinine (P = .023). The learning curve for achieving positive outcomes was noted in >61-90 cases after 66-80 months of performing minimally invasive partial nephrectomy surgeries at a rate of 20 cases per year. Conclusion: RAPN is a safe, feasible procedure with slightly better surgical outcomes than laparoscopic partial nephrectomy (LPN). In the hands of an experienced surgeon, the learning curve for achieving trifecta outcomes can involve a significant number of cases over several years.


Assuntos
Curva de Aprendizado , Nefrectomia/métodos , Procedimentos Cirúrgicos Robóticos/psicologia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Nefrectomia/psicologia , Nefrectomia/normas , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/normas
8.
Psychooncology ; 27(2): 668-675, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29024232

RESUMO

OBJECTIVE: Studies indicate that social constraints (barriers to emotional expression) may be a risk factor for psychological morbidity. We aimed to investigate the association between prostate cancer-related social constraints and psychological well-being following prostate cancer surgery. METHODS: In a group of 3478 partnered patients, participating in the Laparoscopic Prostatectomy Robot Open trial, a prospective multicenter comparative study of robot-assisted laparoscopic and retropubic radical prostatectomy for prostate cancer, we used log-binomial regression analysis to investigate the links between prostate cancer-related social constraints at 3 months after surgery and psychological well-being at 12 and 24 months. RESULTS: A total of 1086 and 1093 men reported low well-being at 12 and 24 months, respectively. Prostate cancer-related social constraints by partner predicted low psychological well-being at 12 months (adjusted RR: 1.4; 95% CI, 1.1-1.9) and by others (adjusted RR: 1.9; 95% CI, 1.1-3.5). Intrusive thoughts mediated the association. CONCLUSIONS: Negative responses from the social environment, especially from partner to talking about the prostate cancer experience affected patients' psychological well-being 2 years after radical prostatectomy. Results emphasize the importance of helping patients mobilize psychosocial resources within their social network, especially among those with a lack of quality psychosocial support.


Assuntos
Sobreviventes de Câncer/psicologia , Prostatectomia/psicologia , Neoplasias da Próstata/psicologia , Qualidade de Vida/psicologia , Procedimentos Cirúrgicos Robóticos/psicologia , Idoso , Seguimentos , Humanos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Satisfação Pessoal , Estudos Prospectivos , Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos
9.
Am J Surg ; 215(2): 277-281, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29137721

RESUMO

BACKGROUND: Current robot surgery curricula developed by industry were designed for expert surgeons. We sought to identify the robotic curricula that currently exist in general surgery residencies and describe their components. METHODS: We identified 12 residency programs with robotic curricula. Using a structured coding form to identify themes including sequence, duration, emphasis and assessment, we generated a descriptive summary. RESULTS: Curricula followed a similar sequence: learners started with online modules and simulation exercises, followed by bedside experience during R2-R3 training years, and then operative opportunities on the console in the final years of training. Consistent portions of the curricula reflect a device-dependent training paradigm; they defined the sequence of instruction. Most curricula lacked specifics on duration and content of training activities. None clearly described cognitive or psychomotor skills needed by residents and none required a proficiency assessment before graduation. CONCLUSIONS: Resident-specific robotic curricula remain grounded in initial industrial efforts to train experienced surgeons, are non-specific regarding the type and nature of hands on experience, and do not include discussion of operative technique and surgical concepts.


Assuntos
Currículo/estatística & dados numéricos , Educação de Pós-Graduação em Medicina/métodos , Cirurgia Geral/educação , Internato e Residência/métodos , Procedimentos Cirúrgicos Robóticos/educação , Competência Clínica , Cognição , Educação de Pós-Graduação em Medicina/estatística & dados numéricos , Humanos , Internato e Residência/estatística & dados numéricos , Desempenho Psicomotor , Procedimentos Cirúrgicos Robóticos/psicologia , Estados Unidos
10.
Am J Surg ; 215(2): 282-287, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29174164

RESUMO

BACKGROUND: Adoption of robotics in general surgery has expanded but there is no mandatory national standardized curriculum for general surgery residents (GSR). METHODS: A survey was administered to all GSRs in 2014 addressing future practice and robotic experience. A non-mandatory robotic curriculum was available for residents to train. Compliance was assessed. In 2016, the same survey was re-administered. Barriers to completing the curriculum were identified. RESULTS: Interest in improving robotic skills remained high (2014 = 97.8% vs 2016 = 95.9%, p = 0.608), and the majority planned to incorporate robotics into future practice (77.8% vs 69.4%; p = 0.358). Only 11 residents (18%) voluntarily completed the curriculum while 36 (60%) started but did not complete. A trend toward increased procedure participation was seen (60.0%-77.6%, p = 0.066). The perceived barriers to completion of the curriculum were length of time required (80%) and lack of access to a simulator (60%). CONCLUSIONS: A structured robotic training curriculum that is non-mandatory is insufficient in helping residents gain fundamental robotic skills.


Assuntos
Atitude do Pessoal de Saúde , Currículo , Cirurgia Geral/educação , Internato e Residência/métodos , Procedimentos Cirúrgicos Robóticos/educação , Estudantes de Medicina/psicologia , Adulto , Competência Clínica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Robóticos/psicologia , Inquéritos e Questionários , Estados Unidos
11.
J Robot Surg ; 12(1): 97-101, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28470407

RESUMO

This was a prospective study to assess positioning-related pain in 20 awake volunteers in the dorsal lithotomy (DL) and lateral decubitus (LD) positions. Each volunteer was put through the series of discrete, sequential steps used to achieve a final position; each step had two options. The Wong-Baker scale (WB) was used to rate pain for each option and the preferred option and ad lib comments were recorded. We found that awake volunteers could clearly and immediately distinguish differences in pain levels between position options. For the DL position, volunteers favored having the arms slightly flexed and pronated as opposed to being straight and supinated reflected by statistically less painful WB scores and option preference. Volunteers preferred having the neck flexed as opposed to being flat. For the LD position, volunteers reported statistically lower pain scores and preference for a foam roll for axilla support as opposed to a rolled blanket, the table flexed without the kidney rest as opposed to a raised kidney rest, and the over arm board as oppose to stacked blankets for contralateral arm support. Ad lib comments from the volunteers supported the above findings. To our knowledge, ours is the first study to demonstrate objective preferences for variations in surgical positioning using awake volunteers. This exercise with awake volunteers resulted in immediate changes in positioning for real robotic surgery patients in our practice.


Assuntos
Dor/etiologia , Posicionamento do Paciente/efeitos adversos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Adulto , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Dor/prevenção & controle , Medição da Dor/métodos , Posicionamento do Paciente/psicologia , Preferência do Paciente , Segurança do Paciente , Estudos Prospectivos , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/psicologia , Procedimentos Cirúrgicos Urológicos/métodos , Procedimentos Cirúrgicos Urológicos/psicologia , Vigília , Adulto Jovem
12.
Health Care Manage Rev ; 43(2): 92-103, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-27782972

RESUMO

BACKGROUND: In recent decades, the role of technology in health care organizations has become increasingly relevant because it enhances health care outcomes and the achievement of clinical goals. Extant research demonstrates that the effectiveness of a medical innovation depends largely on health care professionals' perceptions of its usefulness and impact on their activities and practices. We also know that interaction among social actors contributes to the shaping of their judgments and opinions regarding innovation. PURPOSE: This study investigated the role of professionals' social networks and social capital in the formation of similar individual perceptions about a highly innovative robotic surgical system. METHODOLOGY: We collected data from a sample of 50 professionals, including both physicians and nurses, working in three hospital wards belonging to an Italian hospital organization. Using a survey, we gathered data on professionals' demographic characteristics, the adoption and impact of the new technology, and social networks. We tested our hypotheses using a dyadic perspective and logistic regression quadratic assignment procedures. FINDINGS: Our findings document that professionals' perceptions regarding technological change were more likely to be similar when they were connected and exhibited similarity in some social capital characteristics and adoption behavior. PRACTICE IMPLICATIONS: These results have important implications for health care executives and administrators, as well as for health professionals characterized by high degrees of autonomy and for which organizational change can be affected by professional or organizational resistance.


Assuntos
Atitude do Pessoal de Saúde , Invenções , Equipe de Assistência ao Paciente , Percepção , Rede Social , Difusão de Inovações , Feminino , Hospitais , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Inovação Organizacional , Procedimentos Cirúrgicos Robóticos/psicologia , Inquéritos e Questionários
13.
Laryngoscope ; 128(2): 403-411, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28771728

RESUMO

OBJECTIVES/HYPOTHESIS: To compare quality of life (QOL) of patients who underwent transoral robotic surgery (TORS) alone, with adjuvant radiation therapy (RT), or adjuvant chemoradiation therapy (CRT) in the treatment of oropharyngeal squamous cell cancer (OPSCCA). STUDY DESIGN: Prospective cohort study. METHODS: Medical records were reviewed for 111 patients treated for OPSCCA from 2008 to 2015. Patients were administered the Head and Neck Cancer Inventory (HNCI) to evaluate QOL preoperatively, and at 3 weeks, 3 months, 6 months, and 1 year postsurgery. QOL data were compared between 13 patients treated with TORS alone, 31 with adjuvant RT, and 67 with adjuvant CRT by a linear mixed effects model. RESULTS: Mean follow-up was 35 months. The HNCI response rates at 3 weeks and 3, 6, and 12 months were 80%, 60%, 55%, and 46%, respectively. TORS alone reported significantly higher eating scores than adjuvant RT or CRT at 3 and 6 months, and higher speech scores compared to adjuvant CRT at 3 months and adjuvant RT at 6 months. TORS alone and adjuvant RT reported less social disruption compared to adjuvant CRT at 3 months. Adjuvant CRT had consistently lower overall QOL scores until 6 months. No TORS-alone patient required percutaneous endoscopic gastrostomy, and no study patient required tracheostomy during treatment. CONCLUSIONS: TORS alone maintained higher QOL than adjuvant RT or CRT in eating, social function, speech, and overall QOL postsurgery. QOL and functional metrics were better for 6 months in TORS-alone patients, and at 12 months, the differences were not significant. LEVEL OF EVIDENCE: 4. Laryngoscope, 128:403-411, 2018.


Assuntos
Quimiorradioterapia Adjuvante/psicologia , Cirurgia Endoscópica por Orifício Natural/psicologia , Neoplasias Orofaríngeas/terapia , Qualidade de Vida , Procedimentos Cirúrgicos Robóticos/psicologia , Idoso , Quimiorradioterapia Adjuvante/métodos , Quimioterapia Adjuvante/métodos , Quimioterapia Adjuvante/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Boca/cirurgia , Cirurgia Endoscópica por Orifício Natural/métodos , Neoplasias Orofaríngeas/psicologia , Período Pós-Operatório , Estudos Prospectivos , Procedimentos Cirúrgicos Robóticos/métodos , Resultado do Tratamento
14.
AORN J ; 106(4): 283-294, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28958314

RESUMO

Perioperative leaders at our facility were struggling to meet efficiency targets for robotic surgery procedures while also maintaining the satisfaction of the surgical team. We developed a human resources time and motion study tool and used it in conjunction with the NASA Task Load Index to observe and analyze the required workload of personnel assigned to 25 robotic surgery procedures. The time and motion study identified opportunities to enlist the help of nonlicensed support personnel to ensure safe patient care and improve OR efficiency. Using the NASA Task Load Index demonstrated that high temporal, effort, and physical demands existed for personnel assisting with and performing robotic surgery. We believe that this process could be used to develop cost-effective staffing models, resulting in safe and efficient care for all surgical patients.


Assuntos
Redução de Custos , Eficiência , Procedimentos Cirúrgicos Robóticos/economia , Procedimentos Cirúrgicos Robóticos/normas , Estudos de Tempo e Movimento , United States National Aeronautics and Space Administration , Carga de Trabalho , Pessoal Técnico de Saúde , Humanos , Segurança do Paciente , Admissão e Escalonamento de Pessoal , Procedimentos Cirúrgicos Robóticos/psicologia , Estados Unidos
15.
Jpn J Clin Oncol ; 47(7): 647-651, 2017 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-28419326

RESUMO

Background: To examine how surgical robot emergence affects prostate-cancer patient behavior in seeking radical prostatectomy focusing on geographical accessibility. Methods: In Japan, robotic surgery was approved in April 2012. Based on data in the Japanese Diagnosis Procedure Combination database between April 2012 and March 2014, distance to nearest surgical robot and interval days to radical prostatectomy (divided by mean interval in 2011: % interval days to radical prostatectomy) were calculated for individual radical prostatectomy cases at non-robotic hospitals. Caseload changes regarding distance to nearest surgical robot and robot introduction were investigated. Change in % interval days to radical prostatectomy was evaluated by multivariate analysis including distance to nearest surgical robot, age, comorbidity, hospital volume, operation type, hospital academic status, bed volume and temporal progress. Results: % Interval days to radical prostatectomy became wider for distance to nearest surgical robot <30 km. When a surgical robot emerged within 30 and 10 km, the prostatectomy caseload in non-robot hospitals reduced by 13 and 18% within 6 months, respectively, while the robot hospitals gained +101% caseload (P < 0.01 for all) Multivariate analyses including 9759 open and 5052 non-robotic minimally invasive radical prostatectomies in 483 non-robot hospitals revealed a significant inverse association between distance to nearest surgical robot and % interval days to radical prostatectomy (B = -17.3% for distance to nearest surgical robot ≥30 km and -11.7% for 10-30 km versus distance to nearest surgical robot <10 km), while younger age, high-volume hospital, open-prostatectomy provider and temporal progress were other significant factors related to % interval days to radical prostatectomy widening (P < 0.05 for all). Conclusions: Robotic surgery accessibility within 30 km would make patients less likely select conventional surgery. The nearer a robot was, the faster the caseload reduction was.


Assuntos
Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Idoso , Acesso aos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Preferência do Paciente , Prostatectomia/psicologia , Neoplasias da Próstata/psicologia , Procedimentos Cirúrgicos Robóticos/psicologia , Tempo para o Tratamento
16.
Int J Surg ; 39: 88-94, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28143731

RESUMO

BACKGROUND: Patient-reported outcome measures reveal the quality of surgical care from the patient's perspective. We aimed to compare body image, self-esteem, hospital anxiety and depression, and cosmetic outcomes by using validated tools between patients undergoing robot-assisted surgery and those undergoing conventional open surgery. MATERIALS AND METHODS: This single-center, multidisciplinary, randomized, prospective study of 62 patients who underwent cardiac surgery was conducted at Hospital from May 2013 to January 2015. The patients were divided into two groups: the robotic group (n = 33) and the open group (n = 29). The study employed five different tools to assess body image, self-esteem, and overall patient-rated scar satisfaction. RESULTS: There were statistically significant differences between the groups in terms of self-esteem scores (p = 0.038), body image scores (p = 0.026), overall Observer Scar Assessment Scale (p = 0.013), and overall Patient Scar Assessment Scale (p = 0.036) scores in favor of the robotic group during the postoperative period. Robot-assisted surgery protected the patient's body image and self-esteem, while conventional open surgery decreased these levels but without causing pathologies. Preoperative depression and anxiety level was reduced by both robot-assisted surgery and conventional open surgery. The groups did not significantly differ on Patient Satisfaction Scores and depression/anxiety scores. CONCLUSION: The results of this study clearly demonstrated that a minimally invasive approach using robotic-assisted surgery has advantages in terms of body image, self-esteem, and cosmetic outcomes over the conventional approach in patients undergoing cardiac surgery.


Assuntos
Imagem Corporal , Cicatriz/psicologia , Satisfação do Paciente , Procedimentos Cirúrgicos Robóticos/psicologia , Autoimagem , Adulto , Ansiedade/psicologia , Cicatriz/etiologia , Depressão/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/psicologia , Medidas de Resultados Relatados pelo Paciente , Estudos Prospectivos
17.
J Robot Surg ; 11(3): 325-331, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28130703

RESUMO

The objective of this study is to compare the quality of life (QOL) outcomes between laparoscopic radical prostatectomy (LRP) and robot-assisted radical prostatectomy (RARP). Between July 2007 and July 2013, 229 patients with localized prostate cancer underwent LRP while 105 patients with localized prostate cancer underwent RARP between December 2012 and August 2014. We evaluated their QOL using the 8-item Short-Form Health Survey (SF-8) and Expanded Prostate Cancer Index of Prostate (EPIC) questionnaires at preoperative and at postoperative 3, 6 and 12 months. In the LRP and RARP groups, over 80 and 90% of patients answered questionnaires at each follow-up time, respectively. At baseline QOL of EPIC and SF-8, there was no significant difference between LRP and RARP groups. At postoperative 3 months, Physical and Mental Components of SF-8 and Urinary Summary (U), all Urinary Subscales, Sexual Function and Bowel Function of EPIC showed significantly better scores in RARP group than in LRP group. At postoperative 6 and 12 months, there were no differences between LRP and RARP groups in terms of all QOL scores. RARP group showed better scores in SF-8 as well as urinary and sexual function of EPIC at postoperative-3 months. These differences disappeared at postoperative 6 and 12 months.


Assuntos
Laparoscopia/métodos , Neoplasias da Próstata/psicologia , Neoplasias da Próstata/cirurgia , Qualidade de Vida , Procedimentos Cirúrgicos Robóticos/métodos , Idoso , Incontinência Fecal/psicologia , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/psicologia , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Complicações Pós-Operatórias/psicologia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/psicologia , Disfunções Sexuais Fisiológicas/psicologia , Inquéritos e Questionários , Incontinência Urinária/psicologia
18.
J Minim Invasive Gynecol ; 24(3): 379-396, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28104497

RESUMO

Robotic-assisted surgery is a technological advancement that facilitates the application of minimally invasive techniques for complex operations in gynecologic oncology. The objective of this article was to review the literature regarding the role of robotic-assisted surgery to treat women with gynecologic cancers. The majority of publications on robotic surgery are still retrospective or descriptive in nature; however, the data for managing patients with a robotic-assisted approach show comparable, and at times improved, outcomes compared with both laparoscopy (2-dimensional) and laparotomy approaches. Robotic-assisted surgery has been used for patients with endometrial cancer and resulted in the increased use of minimally invasive surgery with improved outcomes compared with laparotomy and partially with laparoscopy. This has been shown in large cohorts of patients as well as in obese patients in whom the complication rates have significantly decreased. For early cervical cancer, robotic radical hysterectomy seems to be safe and feasible and to be preferable to laparotomy with seemingly comparable oncologic outcomes. Robotic-assisted surgery and conventional laparoscopy to stage women with early-stage ovarian cancer seem to have similar surgical and oncologic outcomes, with a shorter learning curve for robotic-assisted surgery. However, robotic-assisted surgery appears to be more expensive than laparotomy and traditional laparoscopy. In conclusion, robotic-assisted surgery appears to facilitate the surgical approach for complex operations to treat women with gynecologic cancers. Although randomized controlled trials are lacking to further elucidate the equivalence of robot-assisted surgery with conventional methods in terms of oncologic outcome and patients' quality of life, the technology appears to be safe and effective and could offer a minimally invasive approach to a much larger group of patients.


Assuntos
Neoplasias dos Genitais Femininos , Procedimentos Cirúrgicos em Ginecologia , Procedimentos Cirúrgicos Robóticos , Análise Custo-Benefício , Feminino , Neoplasias dos Genitais Femininos/classificação , Neoplasias dos Genitais Femininos/cirurgia , Procedimentos Cirúrgicos em Ginecologia/economia , Procedimentos Cirúrgicos em Ginecologia/métodos , Procedimentos Cirúrgicos em Ginecologia/psicologia , Humanos , Curva de Aprendizado , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Robóticos/economia , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/psicologia , Resultado do Tratamento
19.
J Healthc Qual ; 39(4): 211-218, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-26566237

RESUMO

While use of robotic-assisted surgery has increased rapidly, little is known about the attitudes and beliefs of practicing gynecologists regarding the utility of the technology. We surveyed a large sample of gynecologists to examine their attitudes and beliefs about the benefits, utility, and factors driving use of robotic-assisted gynecologic surgery. A 51-item survey was mailed to 600 fellows or junior fellows of the American College of Obstetricians and Gynecologists. The survey included questions on use of robotic surgery, decision-making, and beliefs regarding the technology. Responses were stratified based on whether the respondent used robotic surgery or not. A total of 310 responses were received including 27.8% who used robotic surgery in their practices. Hysterectomy was the most commonly performed procedure. Opinions about the use and effectiveness of robotic procedures varied based on whether an individual was a robot user. Eighty-two percentage of robot users and 21% of nonrobot users believed robotic surgery provided benefits over laparoscopic (p < .0001). Among both groups, the ability to increase access to minimally invasive surgery and marketing were believed to be the greatest drivers of use of robotic surgery. Attitudes and beliefs about the effectiveness of robotic gynecologic surgery are highly variable among clinicians.


Assuntos
Atitude Frente aos Computadores , Procedimentos Cirúrgicos em Ginecologia/instrumentação , Procedimentos Cirúrgicos em Ginecologia/psicologia , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/psicologia , Médicos/psicologia , Procedimentos Cirúrgicos Robóticos/psicologia , Adulto , Atitude do Pessoal de Saúde , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
20.
J Surg Res ; 206(1): 48-52, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27916374

RESUMO

BACKGROUND: Robot-assisted laparoscopic surgery (RALS) uses 3-dimensional visualization and wristed instruments that provide more degrees of freedom than rigid traditional laparoscopic (TLS) instrumentation. These features have been touted to improve accuracy and efficiency during surgical task performance. Little is known, however, about the transferability of skills between the two platforms or whether task performance on one platform primes surgeons for task performance on the other. METHODS: Twenty-six subjects naïve to RALS were recruited to perform three Fundamentals of Laparoscopic Surgery tasks on both TLS and RALS platforms: peg transfer, pattern cutting (PC), and intracorporeal suturing. All tasks were performed within Fundamentals of Laparoscopic Surgery testing parameters and repeated three times by each subject on each platform. Platform and task order were randomized. Errors in task performance were defined as drops in the peg transfer task, faults 5 mm or more from the defined pattern during PC, and faults greater than 1 mm in suture placement from the defined points in intracorporeal suturing. Mean completion times and mean errors per trial (EPT) were calculated for each task on both platforms. Results were compared between those who performed TLS first (LF) and those who performed RALS first (RF) using unpaired Student's t-test (P < 0.05 considered statistically significant). RESULTS: No statistically significant differences in task completion time were noted between the LF and RF groups. RF subjects had fewer errors during robotic PC than LF subjects (1.02 EPT versus 1.86 EPT, respectively; P = 0.02). No other differences in task quality were noted. CONCLUSIONS: In surgeon's naïve to RALS, there is no evidence that skills acquired on RALS or TLS platforms are transferable to the other platform or that performing tasks on one platform primes a subject for task performance on the other. Performing TLS PC may have had a negative impact on subsequent RALS PC performance. These findings suggest that distinct programs for skills acquisition are necessary for both the TLS and RALS platforms.


Assuntos
Competência Clínica/estatística & dados numéricos , Laparoscopia/psicologia , Curva de Aprendizado , Procedimentos Cirúrgicos Robóticos/psicologia , Humanos , Laparoscopia/instrumentação , Laparoscopia/métodos , Missouri , Projetos Piloto , Procedimentos Cirúrgicos Robóticos/instrumentação , Procedimentos Cirúrgicos Robóticos/métodos , Análise e Desempenho de Tarefas
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