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Original research
Do surgeon non-technical skills correlate with teamwork-related outcomes during robot-assisted surgery?
  1. Youseff Ahmed,
  2. Zaeem Lone,
  3. Ahmed A Hussein,
  4. Yingdong Feng,
  5. Hijab Khan,
  6. Sierra Broad,
  7. Renuka Kannappan,
  8. Alicia Skowronski,
  9. Adam Cole,
  10. Derek Wang,
  11. Kevin Stone,
  12. Adam Hasasneh,
  13. Kevin Sexton,
  14. Amanda Gotsch,
  15. Taimor Ali,
  16. Jacob Braun,
  17. Saira Khan,
  18. Ayesha Durrani,
  19. Mohammad Durrani,
  20. Khurshid A Guru
  1. Urology, Roswell Park Cancer Institute, Buffalo, New York, USA
  1. Correspondence to Dr Khurshid A Guru,Urology, Roswell Park Cancer Institute, Buffalo, New York, USA; Khurshid.Guru{at}roswellpark.org

Abstract

Introduction To evaluate the impact of non-technical skills (NTS) on team performance, workload and clinical outcomes.

Methods The operating room (OR) environment of 20 robot-assisted radical prostatectomies performed by three different surgeons was recorded. Trained observers assessed NTS utilising the Non-Technical Skills for Surgeons (NOTSS) questionnaire. Associations between NOTSS scores, teamwork attributes (anticipation and inconveniences), workload (measured by National Aeronautics and Space Administration-Task Load Index (NASA-TLX)) and clinical outcomes (operative time, blood loss and surgical complexity) were determined using logistic regression and Pearson correlation.

Results 1780 requests were observed, 703 (39%) were non-verbal. Utilisation of non-verbal requests differed significantly among surgeons (26%, 36% and 44%, p<0.001). Anticipation was significantly associated with ‘Situational Awareness’ (OR 2.59, 95% CI 1.52 to 4.38, p<0.001), ‘Decision Making’ (OR 0.42, 95% CI 0.33 to 0.55, p<0.001) and ‘Communication and Teamwork’ (OR 0.43, 95% CI 0.25 to 0.74, p=0.002) domains. Inconveniences were significantly associated with ‘Situational Awareness’ (OR 0.21, 95% CI 0.08 to 0.59, p=0.003), ‘Decision Making’ (OR 2.73, 95% CI 1.53 to 4.86, p<0.001), and ‘Leadership’ (OR 0.62, 95% CI 0.41 to 0.94, p=0.03). There was a significant positive correlation between NOTSS scores and perceived physical and mental workload measures of NASA-TLX, as well as self-perceived performance. There was no significant association between NOTSS scores and any of the investigated clinical outcomes.

Conclusion NTS in the OR were associated with team efficiency, fewer surgical flow disruptions and an improved self-perceived performance.

  • robot-assisted
  • prostatectomy
  • NOTSS
  • quality control
  • non-technical
  • skills
  • leadership

https://doi.org/10.1136/leader-2018-000128

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Footnotes

  • Contributors YA conceptualised the study, took the lead in writing the manuscript and approved the final manuscript as submitted. ZL assisted in data analysis and interpretation, took the lead in revising it and approved the final manuscript as submitted. AAH conceptualised the study, was involved in analysis, critically reviewed the manuscript and approved the final manuscript as submitted. YF assisted in data analysis, critically reviewed the manuscript and approved the final manuscript as submitted. HK assisted in data analysis, critically reviewed the manuscript and approved the final manuscript as submitted. SB assisted in data analysis, critically reviewed the manuscript and approved the final manuscript as submitted. RK assisted in acquisition and analysis of data, critically reviewed the manuscript and approved the final manuscript as submitted. AS assisted in data analysis and interpretation, critically reviewed the manuscript and approved the final manuscript as submitted. AC assisted in data analysis, critically reviewed the manuscript and approved the final manuscript. DW assisted in data analysis, critically reviewed the manuscript and approved the final manuscript. KS assisted in data analysis and interpretation, critically reviewed the manuscript and approved the final manuscript. AH assisted in data analysis, critically reviewed the manuscript and approved the final manuscript. AG assisted in data analysis and interpretation, critically reviewed the manuscript and approved the final manuscript. KS assisted in data analysis and interpretation, critically reviewed the manuscript and approved the final manuscript. TA assisted in data analysis, critically reviewed the manuscript and approved the final manuscript. JB assisted in data analysis, critically reviewed the manuscript and approved the final manuscript. SK assisted in data acquisition and analysis, critically reviewed the manuscript and approved the final manuscript. AD assisted in data acquisition and analysis, critically reviewed the manuscript and approved the final manuscript. MD assisted in data acquisition and analysis, critically reviewed the manuscript and approved the final manuscript. KG conceptualised the study, supervised the data collection, critically reviewed the manuscript, approved the final manuscript and agrees to be accountable for all aspects of the work.

  • Funding This study was supported by Roswell Park Alliance Foundation.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Roswell Park Comprehensive Cancer Center Institutional Review Board (IRB) and study protocol ID: I244113.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are available upon reasonable request.