Issue link: https://viewer.e-digitaledition.com/i/71333
+++++++++++++++++++++++++++++++++++++++++ + + +++++++++++++++++++++++++++++++++++++++++ SPECIAL SECTION: WOMEN'S HEALTH +++ +++ ADVANCES C in Robotic Gynecologic Surgery By Thomas Mendise, MD, MSc, FACOG ONTINUOUS IMPROVEMENT IS mantra for robotic assisted gyne- cological surgery. Minimally invasive approaches to surgery have improved since the first FDA-approved surgical robotic system was introduced in 1999. With more than a decade of clinical use, advances in surgical techniques and equipment changed the way surgeons approach gynecological cases. Challenges for hospitals with high surgical volumes include efficient surgical scheduling to maximize efficient utiliza- tion of equipment while fostering a culture of safety. Innovative Robotic Surgical System Set-Up Using the traditional four-armed set-up in has significant limitations, especially when dealing with complex gynecologic pathology. During challenging gynecologic proce- dures, the conventional set-up can limit a surgeon's ability to retract tissue and create visibility problems. A significant amount of time also is wasted toggling between instrument and camera operation. Due to the limitations of the traditional set-up and increased surgical times, investigators explored other options. In 2007, surgeons started experimenting with various set-ups and decided on adjusting the robotic docking arm, arm positioning, surgical staff utilization and port placement to reduce the limitations of the four-arm set-up. In the new set-up, three robotic arms are used, opening the surgical field to allow for two patient-side ports. This permits the patient-side assistant to assist the surgeon from the head of the bed. Using this configuration, the assistant uses two instruments simultaneously — one for retraction, the other to aid in surgical dissection, retraction and/ or suction-irrigation. There is no need for an additional person in the OR for uterine manipulation. Process Change Reduces OR Turnover Time and Increases Volume Process changes were also made to reduce OR turnover time, including making the OR turnover process a linear rather than parallel process. The concept of parallel processing has been around for a long time. Often used in software development, the concept has been adapted by Summa's robotics department for use in clinical settings. Surgeons who operated on two to three patients per day can now routinely do three to five cases per day, thanks to reduced OR turnover times (reduced from an average of 30-40 minutes to 15 minutes). This change has almost doubled the capacity of the robotic surgical suite — at no additional cost and without affecting patient safety. The new process does require close communication and coordination between all members of the surgical team. Dr. Thomas Mendise is chief of Robotics at Summa Health System. ■ Summa Earns OPSI Best Practice Award for Labor and Delivery Women's health services at Summa Akron City and St. Thomas Hospitals earned an OPSI Best Practice Award from the Ohio Patient Safety Institute (OPSI) for implementation of a program to improve the safety of induction and augmentation of labor, which account for more than half of all births at most institutions. Staff at Summa Akron City Hospital developed a quality bundle, which is a metric of safe and effective care, comprised of evidence-based practices. When bundled together, these practices significantly improved outcomes of procedures with inherent risk. After six months, inductions in full compliance with bundle criteria reached greater than 95 percent per month. The hospital also has maintained zero incidences of birth trauma and injury to infants. 16 | Cleveland-Akron-Canton MD NEWS ■ MDNEWS.COM ■ JULY-AUGUST 2012