Implementation of a new robotic system: challenges for the surgical team and ethical concerns about patient safety, a longitudinal questionnaire study.

Abstract

Introduction: The da Vinci robot continues to be the leading robotic system used in surgery. Following the expiry of its patent, many manufacturers started to develop other systems. We accompanied this sensitive initial phase of implementing a new surgical system in a clinic at which the previously established robotic system has completed its learning curve. Is it ethically justifiable to implement a new robotic system although an established, reliable and low-risk procedure is available?

Research design and methods: We conducted a longitudinal and interdisciplinary questionnaire study from November 2022 to April 2023. Specific questionnaires - answered on a visual analog scale from 1 to 100 - were created for four target groups: surgeons, anesthesiologists, residents, and operating-room (OR) nurses.

Results: A total of 63 participants filled the questionnaire and answered the tailored questions. While the surgeons, along with the OR nurses, initially had the greatest reservations about the Dexter robot and patient safety, their reservations lessened as the number of Dexter procedures performed increased. In contrast, the OR nurses were critical of the new robot and their ratings did not change as the number of Dexter procedures increased. Of all four groups, the residents rated the Dexter robot most positively.

Conclusions: The establishment of a new surgical system that has been approved, yet not established so far, constitutes a major challenge with regard to ethical issues concerning patient safety. A standardized, mandatory curriculum for the entire surgical team would be desirable in order to achieve a similar level of technical expertise as that existing for the established robot system. In addition, we need comprehensible and transparent information for patients. To date, we lack regulations concerning these aspects, which are handled differently in the individual hospitals.