180 degrees, which leaves the anesthetist little access to the patient's
airway and IV lines because they're on the opposite side of the
patient. Precepting nurses should ensure anesthesia double-checks
that their lines will be long enough well before they set foot inside the
OR for the main event.
Training should also highlight the little things your team can do to
prevent an emergency. For example, you can prevent unsafe move-
ment of the OR table after the instruments have been placed in the
patient's body cavity simply by disabling the bed control after dock-
ing.
We prepare our team through detailed simulation training and pre-
procedure discussion — a discussion that encourages everyone on
the OR team to ask, "What happens if …" — as well as during the
time out. We saw how effective this type of preparation and acute
preparation could be during a laparoscopic procedure where the
patient had a bleed. As soon as that happened, our PA was right on
top of the situation, applying suction and doing the repair just as he
should. But something seemed just a bit off, so I said, "Let me just
take a closer look at the suction canister." Turns out, we were using
500ccs of suction when we should have been using maybe 50ccs,
something we were able to fix right away — thanks in large part to
our problem-spotting approach.
4. Put together a contingency plan. There is no harm in
hoping for the best as long as you are prepared for the worst.
Stephen King's famous quote wasn't about robotic surgery — but it
certainly could've been.
OR teams that can create detailed contingency plans for the rare
cases when the robotic procedures don't go as planned are the ones
that will come out of a potentially catastrophic situation unscathed.
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