The pivotal role of the robotic nurse in the management of the robotic urologic surgical environment

IF 0.4 Q4 NURSING

International Journal of Urological Nursing Pub Date : 2024-06-03 DOI:10.1111/ijun.12400

Alice Khalil RN, Marisa Bruno RN, Alessandro Spano MSN, Fabrizio Petrone MSN, Edoardo Ghiani RN, Giuseppe Cosma RN, Giuseppe Chiacchio MD, Rocco Simone Flammia MD

{"title":"The pivotal role of the robotic nurse in the management of the robotic urologic surgical environment","authors":"Alice Khalil RN, Marisa Bruno RN, Alessandro Spano MSN, Fabrizio Petrone MSN, Edoardo Ghiani RN, Giuseppe Cosma RN, Giuseppe Chiacchio MD, Rocco Simone Flammia MD","doi":"10.1111/ijun.12400","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Introduction and Objectives</h3>\n \n <p>Robotic surgery has revolutionized urology. However, upfront costs, time investments and knowledge required to proficiently operate and maintain robotic equipment and supplies often make it advantageous to implement the role of dedicated robotic nurse (DN) teams. Herein, we aimed to investigate the impact of DN on operative times during robotic urological procedures.</p>\n </section>\n \n <section>\n \n <h3> Materials and Methods</h3>\n \n <p>We retrospectively identified consecutive robotic uro-oncological procedures performed at our institution from Jan to Oct 2023. The cohort was stratified based on the presence or absence of a DN team (DN vs no-DN). The DN team was defined as having independently managed ≥100 robotic urological procedures. Endpoints were preoperative nursing time (pre-NT), postoperative nursing time (post-NT), surgeon operative time (surg-OT), and total operative time (t-OT). Continuous variables were compared using Student's <i>t</i>-test. Subgroup analyses were conducted for specific procedures: robot-assisted radical cystectomy (RARC), radical prostatectomy (RARP), partial nephrectomy (RAPN), and radical nephrectomy (RARN).</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Overall, 421 procedures were included. The DN group exhibited shorter pre-NT (13.5 vs 23.7, <i>p</i> < 0.001), post-NT (12.2 vs. 15, <i>p</i> < 0.001), surg-OT (117 vs. 136, <i>p</i> < 0.001), and t-OT (143.2 vs. 174.9, <i>p</i> < 0.001) compared to the no-DN group. Subgroup analysis revealed shorter pre-NT in the DN group for all procedures: RARP (13.2 vs. 23.5, <i>p</i> < 0.001), RARC (16.4 vs. 29.2, <i>p</i> < 0.001), RARN (12.6 vs. 18.9, <i>p</i> < 0.001) and RAPN (12.7 vs. 20.8, <i>p</i> < 0.001). Conversely, DN group exhibited shorter post-NT in RARP (12 vs. 15.8, <i>p</i> < 0.001) and RARN (12.4 vs. 15.3, <i>p</i>: 0.01), but not in RARC (13 vs. 15, <i>p</i>: 0.06) and RAPN (12.2 vs. 12.7, <i>p</i>: 0.4) subgroup. Similarly, DN group demonstrated shorter t-OT in RARP (162.7 vs. 185.4, <i>p</i> < 0.001), but not in RARC (232.8 vs. 245, <i>p</i>: 0.44), RAPN (91.2 vs. 107.4, <i>p</i>: 0.35) and RARN (118.5 vs. 127.2, <i>p</i>: 0.4) subgroups. Finally, no differences in surg-OT were recorded between the DN and non-DN groups for any of the individual procedures (Table 1; Figure 1).</p>\n \n <div>\n \n \n \n \n <header><span>TABLE 1.\n </span>Comparison of time per procedures between dedicated and non-dedicated teams.</header>\n \n \n \n <div>\n <table>\n \n \n \n \n \n \n \n \n \n \n \n \n \n <thead>\n \n <tr>\n \n <th>Variables mean (SD)</th>\n \n <th>RAPN group</th>\n \n <th>Variables mean (SD)</th>\n \n <th>RARP group</th>\n \n <th>Variables mean (SD)</th>\n \n <th>Overall procedures</th>\n </tr>\n \n <tr>\n \n <th>Dedicated nurse team (86)</th>\n \n <th>No dedicated nurse team (35)</th>\n \n <th><i>p</i>-value</th>\n \n <th>Dedicated nurse team (86)</th>\n \n <th>No dedicated nurse team (35)</th>\n \n <th><i>p</i>-value</th>\n \n <th>Dedicated nurse team (86)</th>\n \n <th>No dedicated nurse team (35)</th>\n \n <th><i>p</i>-value</th>\n </tr>\n </thead>\n \n <tbody>\n \n <tr>\n \n <td>Preoperative nursing time</td>\n \n <td>12.7 (±2.7)</td>\n \n <td>20.8 (±5.9)</td>\n \n <td><b><0</b>.<b>001</b></td>\n \n <td>Preoperative nursing time</td>\n \n <td>13.2 (±3.3)</td>\n \n <td>23.5 (±9.8)</td>\n \n <td><b><0</b>.<b>001</b></td>\n \n <td>Preoperative nursing time</td>\n \n <td>13.5 (±3.6)</td>\n \n <td>23.7 (±9.7)</td>\n \n <td><b><0</b>.<b>001</b></td>\n </tr>\n \n <tr>\n \n <td>Postoperative nursing time</td>\n \n <td>12.2 (±3.7)</td>\n \n <td>12.7 (±3.4)</td>\n \n <td>0.4</td>\n \n <td>Postoperative nursing time</td>\n \n <td>12 (±4.1)</td>\n \n <td>15.8 (±6.3)</td>\n \n <td><0.001</td>\n \n <td>Postoperative nursing time</td>\n \n <td>12.2 (±3.9)</td>\n \n <td>15 (±5.6)</td>\n \n <td><0.001</td>\n </tr>\n \n <tr>\n \n <td>Operative time</td>\n \n <td>66.2 (±29.1)</td>\n \n <td>73.8 (±44.4)</td>\n \n <td>0.3</td>\n \n <td>Operative time</td>\n \n <td>137.5 (±37.2)</td>\n \n <td>146.1 (±41.1)</td>\n \n <td>0.18</td>\n \n <td>Operative time</td>\n \n <td>117 (±68)</td>\n \n <td>136 (±68.8)</td>\n \n <td><b><0</b>.<b>001</b></td>\n </tr>\n \n <tr>\n \n <td>Total operation time</td>\n \n <td>91.2 (±30.2)</td>\n \n <td>107.4 (±46.1)</td>\n \n <td>0.35</td>\n \n <td>Total operation time</td>\n \n <td>162.7 (±37.8)</td>\n \n <td>185.4 (±39.6)</td>\n \n <td><b><0</b>.<b>001</b></td>\n \n <td>Total operation time</td>\n \n <td>143.2 (±69)</td>\n \n <td>174.9 (±72,1)</td>\n \n <td><b><0</b>.<b>001</b></td>\n </tr>\n </tbody>\n </table>\n </div>\n \n <div>\n <table>\n \n \n \n \n \n \n \n \n \n <thead>\n \n <tr>\n \n <th>Variables mean (SD)</th>\n \n <th>RARC group</th>\n \n <th>Variables mean (SD)</th>\n \n <th>RARN group</th>\n </tr>\n \n <tr>\n \n <th>Dedicated nurse team (86)</th>\n \n <th>No dedicated nurse team (35)</th>\n \n <th><i>p</i>-value</th>\n \n <th>Dedicated nurse team (86)</th>\n \n <th>No dedicated nurse team (35)</th>\n \n <th><i>p</i>-value</th>\n </tr>\n </thead>\n \n <tbody>\n \n <tr>\n \n <td>Preoperative nursing time</td>\n \n <td>16.4 (±4.8)</td>\n \n <td>29.2 (±8.9)</td>\n \n <td><b><0</b>.<b>001</b></td>\n \n <td>Preoperative nursing time</td>\n \n <td>12.6 (±2.8)</td>\n \n <td>18.9 (±4.7)</td>\n \n <td><b><0</b>.<b>001</b></td>\n </tr>\n \n <tr>\n \n <td>Postoperative nursing time</td>\n \n <td>13 (±3.5)</td>\n \n <td>15 (±4.5)</td>\n \n <td>0.06</td>\n \n <td>Postoperative nursing time</td>\n \n <td>12.4 (±3.9)</td>\n \n <td>15.3 (±5.7)</td>\n \n <td><b>0.01</b></td>\n </tr>\n \n <tr>\n \n <td>Operative time</td>\n \n <td>203.4 (±68.5)</td>\n \n <td>200.8 (±69.7)</td>\n \n <td>0.86</td>\n \n <td>Operative time</td>\n \n <td>93.5 (±38.7)</td>\n \n <td>93 (±42.2)</td>\n \n <td>0.9</td>\n </tr>\n \n <tr>\n \n <td>Total operation time</td>\n \n <td>232.8 (±66.4)</td>\n \n <td>245 (±72.6)</td>\n \n <td>0.44</td>\n \n <td>Total operation time</td>\n \n <td>118.5 (±38.9)</td>\n \n <td>127.2 (±43.1)</td>\n \n <td>0.4</td>\n </tr>\n </tbody>\n </table>\n </div>\n \n \n \n <div>\n <ul>\n <li>\n <i>Note:</i> Bold indicates significant value.\n </li>\n </ul>\n </div>\n <div></div>\n </div>\n \n <section>\n <figure><picture>\n <source></source></picture><figcaption>\n <div><strong>FIGURE 1<span></span></strong><div>Open in figure viewer<i></i><span>PowerPoint</span></div>\n </div>\n <div>Comparison of preoperative nursing time DN Team versus NoDN Team.</div>\n </figcaption>\n </figure>\n </section>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Our study suggests that the implementation of a dedicated robotic nursing team can lead to substantial reductions in overall operative time. This benefit is primarily attributed to shorter preoperative nursing times, highlighting the crucial role of the robotic nurse in optimizing the robotic surgical environment.</p>\n </section>\n </div>","PeriodicalId":50281,"journal":{"name":"International Journal of Urological Nursing","volume":"18 2","pages":""},"PeriodicalIF":0.4000,"publicationDate":"2024-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Urological Nursing","FirstCategoryId":"1085","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/ijun.12400","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"NURSING","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction and Objectives

Robotic surgery has revolutionized urology. However, upfront costs, time investments and knowledge required to proficiently operate and maintain robotic equipment and supplies often make it advantageous to implement the role of dedicated robotic nurse (DN) teams. Herein, we aimed to investigate the impact of DN on operative times during robotic urological procedures.

Materials and Methods

We retrospectively identified consecutive robotic uro-oncological procedures performed at our institution from Jan to Oct 2023. The cohort was stratified based on the presence or absence of a DN team (DN vs no-DN). The DN team was defined as having independently managed ≥100 robotic urological procedures. Endpoints were preoperative nursing time (pre-NT), postoperative nursing time (post-NT), surgeon operative time (surg-OT), and total operative time (t-OT). Continuous variables were compared using Student's t-test. Subgroup analyses were conducted for specific procedures: robot-assisted radical cystectomy (RARC), radical prostatectomy (RARP), partial nephrectomy (RAPN), and radical nephrectomy (RARN).

Results

Overall, 421 procedures were included. The DN group exhibited shorter pre-NT (13.5 vs 23.7, p < 0.001), post-NT (12.2 vs. 15, p < 0.001), surg-OT (117 vs. 136, p < 0.001), and t-OT (143.2 vs. 174.9, p < 0.001) compared to the no-DN group. Subgroup analysis revealed shorter pre-NT in the DN group for all procedures: RARP (13.2 vs. 23.5, p < 0.001), RARC (16.4 vs. 29.2, p < 0.001), RARN (12.6 vs. 18.9, p < 0.001) and RAPN (12.7 vs. 20.8, p < 0.001). Conversely, DN group exhibited shorter post-NT in RARP (12 vs. 15.8, p < 0.001) and RARN (12.4 vs. 15.3, p: 0.01), but not in RARC (13 vs. 15, p: 0.06) and RAPN (12.2 vs. 12.7, p: 0.4) subgroup. Similarly, DN group demonstrated shorter t-OT in RARP (162.7 vs. 185.4, p < 0.001), but not in RARC (232.8 vs. 245, p: 0.44), RAPN (91.2 vs. 107.4, p: 0.35) and RARN (118.5 vs. 127.2, p: 0.4) subgroups. Finally, no differences in surg-OT were recorded between the DN and non-DN groups for any of the individual procedures (Table 1; Figure 1).

TABLE 1. Comparison of time per procedures between dedicated and non-dedicated teams.

Variables mean (SD)	RAPN group	Variables mean (SD)	RARP group	Variables mean (SD)	Overall procedures
Dedicated nurse team (86)	No dedicated nurse team (35)	p-value	Dedicated nurse team (86)	No dedicated nurse team (35)	p-value	Dedicated nurse team (86)	No dedicated nurse team (35)	p-value
Preoperative nursing time	12.7 (±2.7)	20.8 (±5.9)	<0.001	Preoperative nursing time	13.2 (±3.3)	23.5 (±9.8)	<0.001	Preoperative nursing time	13.5 (±3.6)	23.7 (±9.7)	<0.001
Postoperative nursing time	12.2 (±3.7)	12.7 (±3.4)	0.4	Postoperative nursing time	12 (±4.1)	15.8 (±6.3)	<0.001	Postoperative nursing time	12.2 (±3.9)	15 (±5.6)	<0.001
Operative time	66.2 (±29.1)	73.8 (±44.4)	0.3	Operative time	137.5 (±37.2)	146.1 (±41.1)	0.18	Operative time	117 (±68)	136 (±68.8)	<0.001
Total operation time	91.2 (±30.2)	107.4 (±46.1)	0.35	Total operation time	162.7 (±37.8)	185.4 (±39.6)	<0.001	Total operation time	143.2 (±69)	174.9 (±72,1)	<0.001

Variables mean (SD)	RARC group	Variables mean (SD)	RARN group
Dedicated nurse team (86)	No dedicated nurse team (35)	p-value	Dedicated nurse team (86)	No dedicated nurse team (35)	p-value
Preoperative nursing time	16.4 (±4.8)	29.2 (±8.9)	<0.001	Preoperative nursing time	12.6 (±2.8)	18.9 (±4.7)	<0.001
Postoperative nursing time	13 (±3.5)	15 (±4.5)	0.06	Postoperative nursing time	12.4 (±3.9)	15.3 (±5.7)	0.01
Operative time	203.4 (±68.5)	200.8 (±69.7)	0.86	Operative time	93.5 (±38.7)	93 (±42.2)	0.9
Total operation time	232.8 (±66.4)	245 (±72.6)	0.44	Total operation time	118.5 (±38.9)	127.2 (±43.1)	0.4

Note: Bold indicates significant value.

FIGURE 1

Open in figure viewerPowerPoint

Comparison of preoperative nursing time DN Team versus NoDN Team.

Conclusions

Our study suggests that the implementation of a dedicated robotic nursing team can lead to substantial reductions in overall operative time. This benefit is primarily attributed to shorter preoperative nursing times, highlighting the crucial role of the robotic nurse in optimizing the robotic surgical environment.

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机器人护士在机器人泌尿外科手术环境管理中的关键作用

导言和目标机器人手术给泌尿外科带来了革命性的变化。然而，熟练操作和维护机器人设备及耗材所需的前期成本、时间投资和知识往往使专职机器人护士（DN）团队的作用更具优势。在此，我们旨在研究机器人泌尿外科手术中 DN 对手术时间的影响。材料和方法我们回顾性地确定了 2023 年 1 月至 10 月期间在我院进行的连续机器人泌尿肿瘤手术。根据有无 DN 团队（DN vs no-DN）对队列进行分层。DN团队的定义是独立管理过≥100例机器人泌尿外科手术。终点为术前护理时间（pre-NT）、术后护理时间（post-NT）、外科医生手术时间（surg-OT）和总手术时间（t-OT）。连续变量的比较采用学生 t 检验。对特定手术进行了分组分析：机器人辅助根治性膀胱切除术（RARC）、根治性前列腺切除术（RARP）、肾部分切除术（RAPN）和根治性肾切除术（RARN）。结果共纳入 421 例手术。与无 DN 组相比，DN 组的 NT 前（13.5 对 23.7，p < 0.001）、NT 后（12.2 对 15，p < 0.001）、手术-OT（117 对 136，p < 0.001）和 t-OT（143.2 对 174.9，p < 0.001）时间更短。亚组分析显示，DN 组所有手术的前 NT 都更短：RARP (13.2 vs. 23.5, p < 0.001)、RARC (16.4 vs. 29.2, p < 0.001)、RARN (12.6 vs. 18.9, p < 0.001) 和 RAPN (12.7 vs. 20.8, p < 0.001)。相反，DN 组在 RARP（12 vs. 15.8，p < 0.001）和 RARN（12.4 vs. 15.3，p: 0.01）亚组中表现出较短的后 NT，但在 RARC（13 vs. 15，p: 0.06）和 RAPN（12.2 vs. 12.7，p: 0.4）亚组中则没有表现出较短的后 NT。同样，DN 组在 RARP（162.7 vs. 185.4，p < 0.001）亚组中显示出较短的 t-OT，但在 RARC（232.8 vs. 245，p: 0.44）、RAPN（91.2 vs. 107.4，p: 0.35）和 RARN（118.5 vs. 127.2，p: 0.4）亚组中没有显示出较短的 t-OT。最后，DN 组和非 DN 组的手术-OT 在任何单项手术中均无差异（表 1；图 1）。表 1. 专职团队与非专职团队每次手术时间的比较。变量平均值（标清） RAPN 组变量平均值（标清） RARP 组变量平均值（标清）总体手术专职护士团队（86）非专职护士团队（35） p-value 专职护士团队（86）非专职护士团队（35） p-value 专职护士团队（86）非专职护士团队（35） p-value 术前护理时间 12.7（±2.7） 20.8（±5.9） <0.001 术前护理时间 13.2（±3.3） 23.5（±9.8） <0.001 术前护理时间 13.5（±3.

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来源期刊

International Journal of Urological Nursing 医学-护理

CiteScore

0.80

自引率

20.00%

发文量

审稿时长

>12 weeks

期刊介绍： International Journal of Urological Nursing is an international peer-reviewed Journal for all nurses, non-specialist and specialist, who care for individuals with urological disorders. It is relevant for nurses working in a variety of settings: inpatient care, outpatient care, ambulatory care, community care, operating departments and specialist clinics. The Journal covers the whole spectrum of urological nursing skills and knowledge. It supports the publication of local issues of relevance to a wider international community to disseminate good practice. The International Journal of Urological Nursing is clinically focused, evidence-based and welcomes contributions in the following clinical and non-clinical areas: -General Urology- Continence care- Oncology- Andrology- Stoma care- Paediatric urology- Men’s health- Uro-gynaecology- Reconstructive surgery- Clinical audit- Clinical governance- Nurse-led services- Reflective analysis- Education- Management- Research- Leadership The Journal welcomes original research papers, practice development papers and literature reviews. It also invites shorter papers such as case reports, critical commentary, reflective analysis and reports of audit, as well as contributions to regular sections such as the media reviews section. The International Journal of Urological Nursing supports the development of academic writing within the specialty and particularly welcomes papers from young researchers or practitioners who are seeking to build a publication profile.