Presentation Authors: Ann Bisantz, Jeff Higginbotham*, Antara Satchidanand, Gina Aldrich, Ellen Bossert, Buffalo, NY, Taylor Kunkes, Getzville, NY, Mary Walters, Philippa Doherty, Lora A. Cavuoto, Khurshid A. Guru, Buffalo, NY
Introduction: This study examines how the surgical team accomplishes surgical communication at the micro-analytic-level. It documents how verbal, behavioral, and robotic console movements serve to move forward, delay, disrupt, and/or repair communication and activities related to surgical procedures. This taxonomy allows us to identify specific sources, repairs, and outcomes for each communication breakdown, permitting quantitative comparison of breakdown types across team members and their roles, tasks, interaction modes.
Methods: 10 robot-assisted radical prostatectomies (35 hours of recordings) were transcribed and coded by a trained research assistant and 100 interaction exchanges were randomly selected for analysis. Topic-focused interactions were measured for structure, communication grounding, pragmatic function, interaction mode (e.g., voice, pointing), proximity, trouble sources breakdown level, and communication repair strategies. Outcome variables include the type, number, and duration of communication breakdowns.
Results: The number of speaking participants in a given surgery ranged from 2 - 13, with an average of 4.2 ( sd = 1.9). The 100 exchanges were comprised of 3840 utterances, whose frequency varied considerably across surgical roles (Table 1). The Surgeon produced most utterances (33%), meanwhile, others produced utterances which ranged between 10-15%. Questions were asked for 22% of all utterances, and repair-oriented questions occurred for 1/3 of all questions. The core surgical team (Surgeon, Assistant Surgeon, Bedside Assistant) produced most of the questions.The proportion of both overall and repair-oriented questions were distributed equally across participants (chi-square df=6 = 4.03 (p= 0.67)).
Conclusions: The expression of communication problems in Robot-Assisted Surgery are not authority-based, but situation-based. Results from this study will have implications for the design of better surgical communication protocols and will impact training, technology design, and ultimately safety.
Source of Funding: Bisantz & Higginbotham (Co- PIs). Communication in Robotic Assisted Surgery: Detailed Analysis to understand communication success, repair, and the consequences of miscommunication. 2016 IMPACT research grant (University at Buffalo).