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

3 B. Prior to participating in robotic surgery, the CST should complete specific preclinical training for each type of robotic device utilized at the HCF. (1) Due to the complexity of robotic devices, robotic surgery demands the CST to complete didactic and hands-on training that is provided by the device manufacturer and the HDO including ongoing continuing education. 2, 3 a. The HDO is responsible for setting the training and competency requirements for the equipment used on patients. 11 (2) When the HDO purchases a new robotic device including the accessories and instruments, or any new item for the currently used surgical robot the CST should complete continuing education provided by the device manufacturer. 3 (3) The training should initially be observation and familiarization that progresses to hands-on training in a lab/simulated practice to allow the CST to learn the technical skills as well as the ability to efficiently work with the surgical team managing unforeseen situations including trouble-shooting equipment malfunctions or patient emergencies such as internal hemorrhaging. 14 (4) The training should include the following (this list is not all inclusive): a. Preferably, the HDO has a dedicated OR for robotic surgery where the system components are permanently maintained. If not, training should involve proper transportation of the surgeon console, patient cart, and vision cart to the OR that prevents damage to the components. b. How to connect the robot system components. c. Proper setup, draping, and positioning arms. d. Proper technique for white balance and calibration of endoscope and camera. e. Proper technique for inspecting robotic instruments for functionality and defects. f. Proper technique for placing the instruments in the robotic arms and exchange of instruments. g. Proper technique for inserting instruments into trocars as directed by the surgeon. 9 h. Proper technique for removal, exchange, cleaning and re-introduction of the endoscope. i. Proper technique for manipulating/moving the uterus for visualization as directed by the surgeon. (S. Walsh, personal communication, July 21, 2012). j. Proper technique for grasping and inserting the Endo Catch™ or Endobag™. k. Proper techniques regarding how to safely and quickly move the system components in a patient emergency such as internal hemorrhaging. l. Trouble-shooting technical problems, e.g. if the device suddenly stops working or shuts down, arms make independent movements that are potentially unsafe to the patient. m. Assisting with wound closure. n. Proper cleaning, disinfection and sterilization of reusable instruments, accessories and endoscopes used with the robotic device. o. Specific variations for each procedure setup. (5) A HDO should ensure that 3-4 teams consisting of a surgeon, CST, and RN are trained to establish a continuity of patient care. 5