AUA 2018: Does Surgeon Leadership During Robot-Assisted Surgery Correlate With Teamwork-Related Outcomes?

San Francisco, CA ( Youssef Ahmed, MD from the Roswell Park Comprehensive Cancer Center in Buffalo, NY, presented data that described the impact of leadership on team performance and clinical outcomes. Multiple team members are needed in the operating room that all work towards patient safety. Leadership is an integral component of a team, however, Robot-assisted surgery has presented new challenges as the lead surgeon is no longer able to directly interact with the team. 

For this study, 20 robot-assisted radical prostatectomies were observed. The operating room environment was recorded for each of the cases to monitor surgical team behavior and performance. 5 independent and trained observers were asked to observe and score each case. Leadership was assessed using the Non-Technical Skills for Surgeons (NOTSS) where situational awareness, decision making, communication & teamwork, and leadership are scored. Team performance was recorded as the number of inconveniences and anticipations (tasks performed without or before verbal consent). Workload (NASA-TLX Scores) and clinical outcomes (operative time, blood loss, surgical complexity) were also recorded. 

Following analysis, they found a total of 1780 communication events in the 20 cases. 436 (24%) were anticipated and 76 (4%) were inconvenient events. Higher situational awareness was associated with executing tasks by team members prior to being requested. As team anticipation increased, there was also a decreased need for verbal communication and intervention by the lead surgeon. OR environment awareness, communication, and cooperation with team members were found to be associated with mental and physical engagement. There was no significant correlation found between NOTSS and clinical outcomes (operative time, blood loss, surgical complexity). 

Ahmed concluded that from the results, leadership in the OR is associated with team efficiency, fewer surgical flow disruptions, and an improved self-perceived performance. 

Presented by: Youssef Ahmed, MD 
Co-Authors: Ahmed Hussein, Yingdong Feng, Omar Rasool, Hijab Khan, Sierra Broad, Renuka Kannappan, Alicia Skowronski, Adam Cole, Derek Wang, Kevin Stone, Adam Hasasneh, Amanda Gotsch, Kevin Sexton, Taimoor Ali, Saira Khan, Ayesha Durrani, Mohammad Durrani, Khurshid Guru, Buffalo, NY
Author Affiliation: Roswell Park Comprehensive Cancer Center, Buffalo, NY

Written by: Renai Yoon, Department of Urology, University of California-Irvine, medical writer for at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA