CEVL interactive - Promoting effective teamwork to perform robot assisted laparoscopic pyeloplasty in pediatric urology.
Performing pediatric robotic surgeries effectively and efficiently requires the pediatric urologist to “team” with the entire operating room staff. Yet members of this team often achieve competency through different training paths. Attending surgeons often train in a structured, hands-on skills course and then gradually advance to be observed by a mentor. Circulating nurses and surgical technicians typically train together at their home institutions with instructors or by immersion in the operating room. Urology trainees may have opportunity to prepare with review of video clips and a robotic simulator if available, but often do the majority of their learning through immersion in the operating room. Finally, training of anesthesiologists and radiology technicians typically is provided only as an afterthought. To address this situation, the authors created this “CEV-ule” based on their belief that improving the effectiveness of the entire surgical team performance could be achieved by providing the OR staff with a shared online interactive learning for all to use prior to and concurrent with the surgical case. Because pediatric robot-assisted laparoscopic pyeloplasty (RALP) is the most commonly performed pediatric robotic procedure, we chose it as the index case to test this hypothesis. Herein, we present a paradigm approach to RALP. We identified critical points of the procedure in which effective teamwork is essential (e.g., suture passing, instrument exchange). In this manner the surgical workflow may include troubleshooting these points.