1. Troubleshooting training. What if the arm locks up? What
if we lose power? What if the patient makes an unexpected move-
ment that disrupts the entire procedure? What if the table moves
while the trocar is in the patient?
These what-if questions are invaluable to rehearse with your sur-
geon and staff. After all, a minimally invasive robotic surgery can
become an emergency open procedure in an instant. You want to
keep your OR team calm, cool and collected during a robotic emer-
gency — and ensure they perform like a well-oiled machine.
2. Staff accordingly. A typical robotic case generally involves
more than 5 team members, as well as support staff from sterile pro-
cessing and the distribution/sterile processing department. We're also
big believers in using physician assistants (PAs) who are directly
assigned to the robot. The PAs are a godsend because not only are
they experts on the technical aspects, they're also able to move the
big, bulky robots with ease. Before the PAs, our nurses or techs would
move the robots. Because the machinery was so heavy and cumber-
some, some staff got hurt and wound up on disability in the pre-PA
era.
You also need to have adequate back-up personnel at-the-ready in
the event of a problem. For example, if anesthesia runs into a prob-
lem with the lines, extra scrub techs and circulators must be available
to come in right away.
One thing that can't be overstated is the team element of successful
robotic surgeries. The entire OR team — from surgeons to anesthesi-
ologists to nurses to techs — must communicate like a single organ-
ism, ready to adapt and react without delay. That means everybody
must be on high alert. Even during the most mundane processes, like
when you're charting with your back turned, you've got to keep your
1 1 4 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • D E C E M B E R 2 0 1 8
