Understanding Decision Making In Robotic Surgery: A Knowledge Gap Survey and Cognitive Task Analysis of Robotic Prostatectomy

• Main Author: Lusty, Avril
• Other Authors: Wood, Timothy
• Format: Others
• Language: en
• Published: Université d'Ottawa / University of Ottawa 2021
• Subjects: Robotic surgery; Cognitive task analysis; Decision making; Prostatectomy
• Online Access: http://hdl.handle.net/10393/42492; http://dx.doi.org/10.20381/ruor-26712

Robotic surgery is at the forefront of surgical innovation and presents novel challenges for both postgraduate learners and seasoned specialists. Robotic teaching is underway, often without formalized robotic curricula. Research into robotic surgical steps and surgical decision-making that should be imparted to learners has been neglected. As such, I aimed to determine the knowledge gap of urology residents for a robotic prostatectomy. Further, I also aimed to determine the patterns and cognitive rules used by experienced surgeons to complete a robotic prostatectomy. This master’s thesis included a knowledge gap survey, completed by urology residents, and compared to urologic oncologists, of a robotic prostatectomy and contained both open-ended and rating scale questions. A cognitive task analysis (CTA) was then performed as a series of semi-structured interviews in which incident-probing questions were used to make urologic oncologists explain visual cues and decision-making processes. 42 surveys were administered to urology residents and urologists at The Ottawa Hospital over 10 weeks. There was disagreement between urology resident and urologist responses from the rating scale responses, from the following procedural steps: vesicourethral anastomosis, apical dissection, and seminal vesicle dissection. The open-ended responses found discrepancies between the residents’ and urologists’; understanding of anatomy and surgical decision-making, and of cause-and-consequence cognitive awareness. Subsequently, 16 CTA interviews of four urologic oncologists were completed. After data coding and thematic analysis was performed, CTA grids for each surgeon described a map of a robotic prostatectomy including the steps and goals of the procedure, procedural landmarks, key visual cues for each step, complications and/or error prevention, and management. Specific content not yet described in the literature also includes how the lack of haptic feedback is compensated by robotic surgeons. Additional findings included a gap in urology resident knowledge and understanding of a robotic prostatectomy. The CTA of a robotic prostatectomy documented the surgical decision-making rules, patterns and visual cues urologic oncologists use to avoid errors, and to manage intraoperative surgical complications. This information is key to expanding the understanding of robotic prostatectomy surgical decision-making and training and can be used to produce robust robotic educational curricula.