Authors (including presenting author) :
Lam KY(1), Fung CK(1), Ma LF(1), Choi WK(1), Chu KW(2), Leung TF (2), Lo WC (1), Wong YH(2) , Wong MN(2), Szeto L(1), So HS (2)
Affiliation :
1) Department of Anaesthesia and Operating Theatre Services, Tseung Kwan O Hospital.
2) Department of Anaesthesiology, Pain Medicine and Operating Services, United Christian Hospital.
Introduction :
In 2021, KEC was approved to establish our own robotic surgery services. We were facing the challenges of setting up the robotic service in a conventional operating theatre. The existing operating room size in Tseung Kwan O Hospital (TKOH) is only 36.71 square metres, which is about two-fifths smaller than the average robotic theatre in Hong Kong. The conventional design of the operation room without the Endo-Lap setting is one of the limitations. Transforming the existing operating room to a multifunctional advanced robotic theater became a challenging mission to accomplish.
Objectives :
To achieve a safe and efficient robotic surgery service with a tailor-made infrastructure, workflow and practice.
Methodology :
In order to establish robotic surgical services in the existing infrastructure in TKOH, various modifications were implemented. To ensure a safe working environment in limited space, tailor-made trolleys were designed to handle the delicate robotic instruments. Also, the long and bulky power cords were secured systematically on the wall to prevent tripping.
Before implementation of the service, we conducted drills for different specialties. During the drills, surgeons, anaesthesiologists, nurses, anaesthetic assistants and vendor representatives worked together to decide on the workflows, patient’s positioning, robotic OT table synchronization and the layout of instruments and equipment. The second surgeon console is allocated in the specially designed area outside the operation room, which also supports real-time manipulation of the robotic system and simulator training. The team agreed to drape the robotic arms in advance with a sterile protective screen and allocate the patient cart in the designated area, in order to maximize the working area during positioning of patient. It also increases staff awareness of the sterile field around robotic arms.
KEC Robotic Surgery is the pioneer in Hospital Authority to apply 5G technology intraoperatively to support real-time remote supervision and teleconsultation to enhance patient safety and efficiency. Meanwhile, it can maximize perioperative training capacity.
Result & Outcome :
Between April 2022 and May 2023, KEC robotic surgery services were launched in six specialties at TKOH. Six specialties include Urology, Gynaecology, Lower Gastro-Intestinal, Upper Gastro-Intestinal, Hepato-Biliary-Pancreato and ENT surgery. Since 2021, 50 KEC nurses have undergone robotic training and become accredited as robotic nurses. Around 250 robotic operations are completed successfully until Dec 2023.
In 2023, a satisfaction survey was conducted among 56 KEC robotic team members, which included anaesthesiologist (14.3%), Robotic surgeon (21.5%), OT nurses (57.1%) and anaesthetic assistants (7.1%). The results of this survey revealed that 71.4% of the respondents expressed satisfaction with the modifications made to the environment and setting in the robotic theatre. 89.3% of respondents were satisfied with the changes in the workflow and introduction of new practices. 92.9% of respondents were satisfied with the overall team competencies and collaboration.
Advanced technology such as 5G, VR and AI could further optimize the services in the future. Ongoing improvements will be implemented to enhance the safety and efficiency of robotic surgery services, team collaboration and to achieve clinical excellence.
