Comparative analysis of disruptive events in robotic and laparoscopic radical prostatectomy.

Abstract

This study compares laparoscopic (LRP) and robotic-assisted (RARP) radical prostatectomy to identify external and internal disruptive events, focusing on tasks that require heightened attention and coordination among the surgical team. Observations conducted across three hospitals in Australia and China. Data collection was rigorously ensured through the analysis of video recordings and consultations with surgeons, followed by statistical analysis using the Wilcoxon Signed Rank test. In a sample of 54 surgeries (27 RARP, 27 LRP), 15 activities were analysed, identifying 23 internal and 38 external disruption types. The findings indicate that RARP significantly reduces both external and internal disruptions compared to LRP, with decreases of around 41% and 33%, respectively. Notably, neurovascular bundle release showed the highest internal disruptions, with 123 events in RARP and 160 in LRP, and minor vessel bleeding led to the most internal disruptions, with 200 in RARP and 251 in LRP. RARP advantages include fewer disruptions due to pre-dissection inspections for visibility, improved blood management, and a skilled assistant, reducing the need for direct eye contact and repeated instructions. This study adds new dimensions to existing research by comparing internal and external disruptions in complex surgeries-specifically radical prostatectomy-performed using two approaches: robotic-assisted and laparoscopic.