Mr A El-GhobashyConsultant gynae-

oncology

Mr D MurphyClinical Director

Gynaecology

Dezita Taylor Angela Davis

Joanne Williams

To describe the nursing experience in developing the Robotic surgery service in Gynaecological Oncology in Wolverhampton

To understand how the Nurses are involved such type of Robotic surgery

HOME SWEET HOME“ An organisation that is striving continuously to improve patient experience and outcomes “

Technological advances have helped make positive

changes to todays surgical practice

Conventional laparoscopic surgery has been carried out at the RWH successfully for years

In June 2011 the RWH purchased the Da Vinci surgical robotic system

Patients are at the centre of all that we do

We will always be innovative

We create an environment in which people thrive

We empower people to explore new ideas

Improved visualisation for the surgeon

Improved dexterity

Improved camera stability

Improved surgeon ergonomics

Can reduce patient pain and trauma

Quicker healing time compared to some open procedures

Early discharge for patients

Robots have poor judgment

Expensive to obtain and also to fix

System errors

“ the mere existence of a robotic system does not constitute a successful robotics program” (Sullivan et al, 2008)

Team leaders(scrub, anaesthetics

and recovery)

Anaesthetic team

The scrub team

Theatre support assistants

“ it was quite exciting and daunting to be involved in robotic surgery, although the anaesthetic checks are still the same as any laparoscopic procedure, I realised that there would be a lot more emphasis on patient positioning and the physiological effects that steep trendelenburg has on patients. We also had to think of the anaesthetists preferences for example some were happy to anaesthetise and position the patient in the anaesthetic room so that when the patient came into theatre everything was ready others were not, we had to assess each robotic anaesthetic individually”.

Tracey WaldronSenior ODP

ANAESTHETIC ROLE

Protector of the patient

Extended surgical time

Patient positioning

Maintaining patient normo-thermia

New responsibilities

Preparation of the system

Troubleshooting

New instruments and technology

Different communication techniques

Staff training: “staff education is the foundation for initiating any successful robotic program” (Zender, Thell, 2010)

“new procedures alongside technical advances can potentially be time consuming until the surgeon and the team have gained the necessary skills” (Martin et al, 2004)

Staff motivation

Communication

LOGISTICS

Instrumentation

Early starts/late finishes

New technology: “staff have to overcome the technophobia allowing the integration of new complicated technologies into the operating room” (Martin et al, 2004)

Staffing levels

Stocking up of the theatre

Obtaining a theatre slot

Training in Paris

Guidance from the proctors and reps

Logistics

Organisation

Introducing new members

Surgeons preferences

Liaising with other specialities

“ I first thought that robotic surgery was hard going and laborious mainly due to the fact that it was new and there was only one team, now we have a structured routine and are developing more teams our confidence has grown ”. Angela Davis, Sister.

“ I was sceptical about robotic surgery at first, I was worried about the length of time the patient was on the operating table due to it being a new procedure however when I learnt that patients were going home the next day in some cases and saw how well they looked I could really see the benefits” Joanne Williams, theatre Scrub Nurse

Within the clinical setting

Education

Administration

Research

Professional development

Francis (2006)

To arrange the surgical robotic system

To calibrate and start the system

Draping of the surgical robot and camera

Setting up the vison cart

To identify and address faults

To record data from the surgical system

To perform a shutdown of the system

To be knowledgeable about the robotic instruments, and how they are sterilised

Improved patient protection

Robotic education folder

Logbooks and reflective practice

Robotic surgical assistant

• It has been a steep learning curve for the Robotic team in Wolverhampton; one that included a radical change for all involved.

• With correct training, education and maintaining competencies, we expect to deliver gold standard care to all of our patients.

• Study days, conferences and hospital visits would allow exchange of experience with other robotic teams.

• We recommend having a set of competencies established that surely would benefit all of the involved staff.