A European survey on non-technical skills in robotic thoracic surgery for lung resections.

Objectives: In robotic surgery, interaction between team-members differs from that in open surgery, which impacts the team-members' tasks and responsibilities. Training for robot-assisted thoracic surgery (RATS) is primarily focused on technical skills. However, non-technical skills (NOTECHS) are equally important for safe and high-quality surgery. There is debate whether NOTECHS require adjustments to meet specific needs of RATS. The aim of this study is to evaluate how NOTECHS-domains are perceived, performed and trained in European robotic thoracic centers.

Methods: A digital exploratory survey was distributed amongst 40 robotic thoracic surgeons in 33 European centers. The survey contained 40 questions concerning the setting, team, robotic platform, operating room set-up, briefing & debriefing (B&D), and NOTECHS.

Results: Survey response rate was 85%. A training program for RATS is offered by 38%. There is a wide variety in team composition and set-up in the operating room. The B&D checklist is essentially the same as for open surgery. A conversion protocol is available for 85% of surgeons, but 11% is not aware of its contents. Among the four NOTECHS-domains, communication&teamwork is considered most important, followed by situational awareness. In some centers, team-training in NOTECHS is either lacking (36%) or provided only once (33%).

Conclusions: Although the importance of NOTECHS in RATS is widely recognized among European robotic surgeons, focused and structured team-training in these skills is lacking. Furthermore, a conversion protocol is not always available or known. These findings offer room for improvement and encourage further research.