AST Guideline - Perioperative Role and Duties of the Surgical Technologist During Robotic Surgical Procedures

11 B. The system has the internal ability to allow the surgical team to interact “live” with technical engineers at Intuitive Surgical, Inc. 8 (1) The system is connected through the Internet and transmits computerized messages to the technical engineers. The engineers log-in and can read what the team is seeing on the monitors in the OR allowing them to diagnose the problem and possibly fix it from the Intuitive Surgical, Inc. headquarters. 8 (2) When a technical error occurs, the team must follow the instructions displayed on the monitors. There are two faults: “recoverable” and “nonrecoverable”. a. A recoverable fault is a technical error and the surgical procedure can continue after the team has confirmed the error and fixed it. The system has a set of alarms to indicate a recoverable fault as well as messages on the monitors and flashing LEDs on the patient cart arms. The system locks when the fault occurs and is unlocked by the team once it is resolved. b. A nonrecoverable fault cannot be fixed; the team must shut down the system and convert to an open procedure. Guideline IX The CST must be prepared for conversion to an open procedure such as in the event of a nonrecoverable fault of the robotic system or patient emergency, e.g., unanticipated hemorrhaging. A. The CST must exhibit the proper knowledge and skills to quickly and safely assist the surgical team by properly removing and placing on the sterile back table the endoscope, camera, and instruments to allow the circulator to move components away from the sterile field. (1) An emergency power-off button is located on the back of the surgeon console that will completely turn off the power to the whole system. (2) The CST must remove the instruments and endoscope from the patient, and disconnect the arms from the sheaths to allow the circulator to undock the patient cart. A well-trained team performing in a coordinated effort should complete these actions in two to four minutes. 9 Postoperative Guidelines Guideline X The CST is responsible for break-down of the sterile back table including the initial decontamination of the robotic instrumentation and accessory items. 1. The first step in the decontamination process occurs in the operating room (point-of- use). 5 A. The CST is responsible for pre-soaking the contaminated instruments to prevent organic material from drying prior to transport in the case cart to the decontamination room. (1) The CST must follow the robotic manufacturer’s instructions for the decontamination of the endoscopes, instrumentation and accessory items. (2) The CST must exhibit careful technique handling robotic items when placing in the pan(s) for pre-soaking, placing the pans in the case cart, and transporting to the decontamination room to prevent damage to the items.