Background

Undeniably, robotic-assisted surgery (RAS) has become very popular in recent decades, but it has introduced challenges to the workflow of the surgical team. Non-technical skills (NTS) have received less emphasis than technical skills in training and assessment. The systematic review aimed to update the evidence on the role of NTS in robotic surgery, specifically focusing on evaluating assessment tools and their utilisation in training and surgical education in robotic surgery.

Methods

A systematic literature search of PubMed, PsycINFO, MEDLINE, and EMBASE was conducted to identify primary articles on NTS in RAS. Messick’s validity framework and the Modified Medical Education Research Study Quality Instrument were utilised to evaluate the quality of the validity evidence of the abstracted articles.

Results

Seventeen studies were eligible for the final analysis. Communication, environmental factors, anticipation and teamwork were key NTS for RAS. Team-related factors such as ambient noise and chatter, inconveniences due to repeated requests during the procedure and constraints due to poor design of the operating room may harm patient safety during RAS. Three novel rater-based scoring systems and one sensor-based method for assessing NTS in RAS were identified. Anticipation by the team to predict and execute the next move before an explicit verbal command improved the surgeon’s situational awareness.

Conclusion

This systematic review highlighted the paucity of reporting on non-technical skills in robotic surgery with only three bespoke objective assessment tools being identified. Communication, environmental factors, anticipation, and teamwork are the key non-technical skills reported in robotic surgery, and further research is required to investigate their benefits to improve patient safety during robotic surgery.

中文翻译：

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机器人辅助手术中非技术技能的评估和应用：系统评价

背景

不可否认，机器人辅助手术（RAS）在近几十年来变得非常流行，但它给手术团队的工作流程带来了挑战。在培训和评估中，非技术技能 (NTS) 受到的重视程度低于技术技能。该系统综述旨在更新有关 NTS 在机器人手术中作用的证据，特别侧重于评估评估工具及其在机器人手术培训和手术教育中的使用。

方法

对 PubMed、PsycINFO、MEDLINE 和 EMBASE 进行系统文献检索，以确定有关 RAS 中 NTS 的主要文章。梅西克的有效性框架和改良医学教育研究质量工具用于评估摘要文章有效性证据的质量。

结果

十七项研究符合最终分析的条件。沟通、环境因素、预期和团队合作是 RAS 的关键 NTS。与团队相关的因素，例如环境噪音和闲聊、手术过程中重复请求造成的不便以及手术室设计不良造成的限制，可能会在 RAS 期间损害患者安全。确定了三种新型的基于评分者的评分系统和一种基于传感器的方法来评估 RAS 中的 NTS。团队在明确的口头命令之前预测并执行下一步行动的预期提高了外科医生的态势感知能力。

结论

这项系统评价强调了机器人手术非技术技能报告的缺乏，仅确定了三种定制的客观评估工具。沟通、环境因素、预期和团队合作是机器人手术中报告的关键非技术技能，需要进一步研究来调查它们对提高机器人手术期间患者安全的益处。