ObjectiveTo examine evidence of sensitivity, predictiveness, and methodological concerns regarding direct, objective measures of situation awareness (SA).BackgroundThe ability to objectively measur...

A Systematic Review and Meta-Analysis of Direct Objective Measures of Situation Awareness: A Comparison of SAGAT and SPAM.

Human factors in robotic assisted surgery: Lessons from studies 'in the Wild'.

A review of 37 studies that included both objective and subjective measures of situation awareness (SA) was conducted. Objective and subjective measures of SA were found to diverge across a wide ra...

https://journals.sagepub.com/doi/pdf/10.1177/1555343419874248

The Divergence of Objective and Subjective Situation Awareness: A Meta-Analysis:

Robotic systems introduced new surgical and technical demands. Surgical flow disruptions are critical for maintaining operating room (OR) teamwork and patient safety. Specifically for robotic surgery, effects of intra-operative disruptive events for OR professionals’ workload, stress, and performance have not been investigated yet. This study aimed to identify flow disruptions and assess their association with mental workload and performance during robotic-assisted surgery. Structured expert-observations to identify different disruption types during 40 robotic-assisted radical prostatectomies were conducted. Additionally, 216 postoperative reports on mental workload (mental demands, situational stress, and distractions) and performance of all OR professionals were collected. On average 15.8 flow disruptions per hour were observed with the highest rate after abdominal insufflation and before console time. People entering the OR caused most flow disruptions. Disruptions due to equipment showed the highest severity of interruption. Workload significantly correlated with severity of disruptions due to coordination and communication. Flow disruptions occur frequently and are associated with increased workload. Therefore, strategies are needed to manage disruptions to maintain OR teamwork and safety during robotic-assisted surgery.

Effects of Flow Disruptions on Mental Workload and Surgical Performance in Robotic-Assisted Surgery

Adaptation as a source of safety in complex socio-technical systems: A literature review and model development

Recent studies exploring the effects of surgical robots on teamwork are revealing challenges not reflected in clinical studies. This study is a sub analysis of observational data collected from 89 procedures utilising the da Vinci systems. Previous analyses had demonstrated interactions between flow disruptions and contextual factors. This study sought a more granular analysis to provide better insight for improvement. Raters sub-classified disruptions, based upon the original notes, grouped according to four operative phases (pre-robot; docking; surgeon on console; undocking; and finish). The need for repeated utterances; additional supplies retrieval; fogging or matter on the endoscope and procedure-specific training were particularly disruptive. Variations across phases reflect differing demands across the operative course. Combined qualitative and quantitative observational methodologies can identify otherwise undocumented sources of process variation and potential failure. Future observationa...

Diagnosing barriers to safety and efficiency in robotic surgery

Associations of Intraoperative Flow Disruptions and Operating Room Teamwork During Robotic-assisted Radical Prostatectomy.

Introduction: We sought to apply the principles of human factors research to robotic-assisted radical prostatectomy to understand where training and integration challenges lead to suboptimal and inefficient care. Materials and methods: Thirty-four robotic-assisted radical prostatectomy and bilateral pelvic lymph node dissections over a 20 week period were observed for flow disruptions (FD)- deviations from optimal care that can compromise safety or efficiency. Other variables physician experience, trainee involvement, robot model (S versus Si), age, body mass index (BMI), and American Society of Anesthesiologists (ASA) physical status were used to stratify the data and understand the effect of context. Effects were studied across four operative phases- entry to insufflations, robot docking, surgical intervention, and undocking. FDs were classified into one of nine categories. Results: An average of 9.2 (SD = 3.7) FD/hr were recorded, with the highest rates during robot docking (14.7 [SD = 4.3] FDs/hr). The three most common flow disruptions were disruptions of communication, coordination, and equipment. Physicians with more robotic experience were faster during docking (p < 0.003). Training cases had a greater FD rate (8.5 versus 10.6, p < 0.001), as did the Si model robot (8.2 versus 9.8, p = 0.002). Patient BMI and ASA classification yielded no difference in operative duration, but had phase-specific differences in FD. Conclusions: Our data reflects the demands placed on the OR team by the patient, equipment, environment and context of a robotic surgical intervention, and suggests opportunities to enhance safety, quality, efficiency, and learning in robotic surgery.

Surgical flow disruptions during robotic-assisted radical prostatectomy.

Most users with low vision benefit from enlarged content in documents. One method for enlarging web content is using screen magnification software (SMS). This typically requires horizontal scrolling. Another enlargement method uses web browser zoom controls. If the author uses a coding technique like responsive web design (RWD), browser zoom enables automatic word wrapping and no horizontal scrolling. The purpose of the present study was to compare how these two different magnification methods affect reading comprehension and visual fatigue of people with low vision when reading on a computer screen. Participants read passages and answered comprehension questions on a computer. Each participant used either SMS or RWD to enlarge content. Performance (accuracy to reading comprehension questions and time-on-task) and measures of user experience (ratings of usability, visual fatigue, and nausea) were obtained. Although no differences in reading comprehension were obtained, participants reported higher levels of usability and lower levels of nausea when reading with RWD for about an hour as compared to when reading with SMS. Based on post-study interviews with participants, the nausea was likely due to the need to scroll horizontally for extended periods of time. Thus, use of SMS without a means to eliminate or reduce horizontal scrolling for the user can lead to reading discomfort and lower user experiences for adults with low vision.

How Screen Magnification with and Without Word-Wrapping Affects the User Experience of Adults with Low Vision

Screen magnifiers, which often result in the need for horizontal scrolling, and enlarging content through the browser itself are two magnification methods used by computer-users with low vision. With responsive web design (RWD), the later can be done with word wrapping, thus eliminating the need to horizontally scroll. The present study compared the effectiveness of the two methods when participants performed two types of Web-based tasks: reading comprehension and data input. Results showed that when using RWD, participants completed the reading comprehension tasks more quickly and accurately compared to when using screen magnifiers. Participants were also able to complete data input more quickly with RWD than with the screen magnifier. Finally, participants rated RWD to be more usable than screen magnifiers. The results of this study have implications for further developments of web accessibility guidelines.

Elyse C. Hallett

Papers

Diagnosing barriers to safety and efficiency in robotic surgery

Associations of Intraoperative Flow Disruptions and Operating Room Teamwork During Robotic-assisted Radical Prostatectomy.

Surgical flow disruptions during robotic-assisted radical prostatectomy.

How Screen Magnification with and Without Word-Wrapping Affects the User Experience of Adults with Low Vision

The Usability of Magnification Methods: A Comparative Study Between Screen Magnifiers and Responsive Web Design