Medical Robotics Popularity Leads to New Specialists, New Educational Necessities
The robotic surgery sensation is not only transforming care, but improving the jobs market and affecting intellectual property trends as well
By John J. Otrompke, JD
On a typical day at work, Patricia Francois, RN, begins the day by readying operating rooms at Advocate Lutheran General Hospital in Park Ridge, Illinois. “We have to get the room set up an hour and a half before the patient even comes into the room,” Francois said.
“Three nurses are involved in each case,” she continued. “One team member scrubs in to assist the surgeon at the sterile field, and the other two team members are circulating nurses which are very necessary to share the role of taking care of the patient , documenting the procedure , and troubleshooting any issues that occur during the operation. If there is a troubleshooting issue occurring in a room that I am not present in at that time, and the nurse in that room is capable of trouble-shooting, then I am called into the room to assist,” she said.
Nurses everywhere may be used to busy case loads, but Francois is extra dynamic, because her cases are not ordinary cases; she is the surgical robotics coordinator at Advocate Lutheran General, and when she is not busy in the operating room, she is occupied with putting together educational curricula for an entirely new field of specialty: the medical robotics nurse. [See attached article].
“I created a resource book, called “The Robotics Resource Manual,” which has pictures of the surgical room set-up. For each procedure (robotic prostrate surgery, for example), it will tell you where to put the patient side cart, because you have to put the robotic arms or the patient side cart in the right place during the procedure to make it easier for the surgeon. (For prostate cases, it is placed at the foot of the bed, whereas for liver resection, it has to go at the head of the bed). And I have some anatomical pictures with information explaining the robotic procedures, as well as a log of different types of trays, and a log of different types of Da Vinci trays and single instrumentation available, as well as doctor-specific preference cards for each case if the procedure gets converted to an ‘open.’ For example, I have in there how to access error log if you have a problem during a case,” Francois said.
The nursing manual is the first of its kind in existence, but Francois said it is for use for in-house use only so far. This manual is hospital-specific with professional robotic room set-up pictures created by robotic team nurses and media team services. The nursing manual is the first of its kind in existence, but Francois said it is for use only in-house so far. Not even Lutheran General’s sister hospitals use the manual.
“One of my goals for 2008 is to teach a robotics preceptorship for other Advocate hospitals, and once we offer that course I will have the opportunity to share those surgical illustrations with them,” she said.
A Booming Business
While Advocate Lutheran General already owns two da Vinci surgical robots, the hospital is considering purchasing a third, because the cases are coming in quickly. “We have the standard Da Vinci and the Da Vinci S, and two upgraded robot-specific operating rooms,” Francois said. The hospital is doing as many as 3 or 4 cases per day, and up to 6 robotic surgery cases per week. Last year, Advocate Lutheran General hospital handled over 200 robotic cases, she said. But with those cases, come technical difficulties, she said.
“Intuitive has provided representatives that have taught the robotic team nurses and myself how to trouble-shoot certain problems which occur during a procedure. “The robot will alarm if something occurs that the system doesn’t like, such as if the doctor is too rough with the instrumentation or uses jerky movements. It’ll let you know what the problem is. You just acknowledge the alarm by hitting a button, and it clears itself.
“But sometimes if you do something, such as repeated non-intuitive motion, the robot will sometimes give you a non-recoverable fault, and lock you out, and its not going to let you go forward until you fix the problem. Me being coordinator, if I can’t solve the problem, I have an 800 number, and it will take you right to Intuitive technical support, and talk to a live engineer, in about 30 seconds if you’re in the middle of a case. That’s if I don’t have an Intuitive representative in the room with me,” said Francois.
The robot creates a page of errors as they occur during a case, and these errors are translated as codes which are stored in what’s called an error log in the system. “I’m reciting line by line from a whole page of errors that’s on the monitor, and the engineer I’m speaking to has a book of codes, and helps me to identify and solve the problem,” she said.
At the beginning, the Intuitive representative was present for 98% of the cases, she continued. Now that the hospital has been doing robotic surgeries for several years, the original rep hasn’t been in all the time, “but we do have a new representative who has been here to help support a new surgeon beginning to use the robot,” she continued.
Another of Francois’ new duties as coordinator involves facilitating a semi-monthly meeting of the entire robotics team of 17 multi-service staff members, to discuss any updates, research topics, or problems which have occurred. “Communication and teamwork is the number one key to having a successful robotics program,” she said.
Still, notwithstanding the learning curve, Francois said, “overall, it is just fantastic what the surgeons are able to do robotically. We did a robotic inguinal hernia the other day, and it took an hour and a half total room time. And when you view the 3-D image, as opposed to a two-dimensional laparascopic image, you can see small, delicate vessels, and they are much more defined,” she said.
By John J. Otrompke, JD
On a typical day at work, Patricia Francois, RN, begins the day by readying operating rooms at Advocate Lutheran General Hospital in Park Ridge, Illinois. “We have to get the room set up an hour and a half before the patient even comes into the room,” Francois said.
“Three nurses are involved in each case,” she continued. “One team member scrubs in to assist the surgeon at the sterile field, and the other two team members are circulating nurses which are very necessary to share the role of taking care of the patient , documenting the procedure , and troubleshooting any issues that occur during the operation. If there is a troubleshooting issue occurring in a room that I am not present in at that time, and the nurse in that room is capable of trouble-shooting, then I am called into the room to assist,” she said.
Nurses everywhere may be used to busy case loads, but Francois is extra dynamic, because her cases are not ordinary cases; she is the surgical robotics coordinator at Advocate Lutheran General, and when she is not busy in the operating room, she is occupied with putting together educational curricula for an entirely new field of specialty: the medical robotics nurse. [See attached article].
“I created a resource book, called “The Robotics Resource Manual,” which has pictures of the surgical room set-up. For each procedure (robotic prostrate surgery, for example), it will tell you where to put the patient side cart, because you have to put the robotic arms or the patient side cart in the right place during the procedure to make it easier for the surgeon. (For prostate cases, it is placed at the foot of the bed, whereas for liver resection, it has to go at the head of the bed). And I have some anatomical pictures with information explaining the robotic procedures, as well as a log of different types of trays, and a log of different types of Da Vinci trays and single instrumentation available, as well as doctor-specific preference cards for each case if the procedure gets converted to an ‘open.’ For example, I have in there how to access error log if you have a problem during a case,” Francois said.
The nursing manual is the first of its kind in existence, but Francois said it is for use for in-house use only so far. This manual is hospital-specific with professional robotic room set-up pictures created by robotic team nurses and media team services. The nursing manual is the first of its kind in existence, but Francois said it is for use only in-house so far. Not even Lutheran General’s sister hospitals use the manual.
“One of my goals for 2008 is to teach a robotics preceptorship for other Advocate hospitals, and once we offer that course I will have the opportunity to share those surgical illustrations with them,” she said.
A Booming Business
While Advocate Lutheran General already owns two da Vinci surgical robots, the hospital is considering purchasing a third, because the cases are coming in quickly. “We have the standard Da Vinci and the Da Vinci S, and two upgraded robot-specific operating rooms,” Francois said. The hospital is doing as many as 3 or 4 cases per day, and up to 6 robotic surgery cases per week. Last year, Advocate Lutheran General hospital handled over 200 robotic cases, she said. But with those cases, come technical difficulties, she said.
“Intuitive has provided representatives that have taught the robotic team nurses and myself how to trouble-shoot certain problems which occur during a procedure. “The robot will alarm if something occurs that the system doesn’t like, such as if the doctor is too rough with the instrumentation or uses jerky movements. It’ll let you know what the problem is. You just acknowledge the alarm by hitting a button, and it clears itself.
“But sometimes if you do something, such as repeated non-intuitive motion, the robot will sometimes give you a non-recoverable fault, and lock you out, and its not going to let you go forward until you fix the problem. Me being coordinator, if I can’t solve the problem, I have an 800 number, and it will take you right to Intuitive technical support, and talk to a live engineer, in about 30 seconds if you’re in the middle of a case. That’s if I don’t have an Intuitive representative in the room with me,” said Francois.
The robot creates a page of errors as they occur during a case, and these errors are translated as codes which are stored in what’s called an error log in the system. “I’m reciting line by line from a whole page of errors that’s on the monitor, and the engineer I’m speaking to has a book of codes, and helps me to identify and solve the problem,” she said.
At the beginning, the Intuitive representative was present for 98% of the cases, she continued. Now that the hospital has been doing robotic surgeries for several years, the original rep hasn’t been in all the time, “but we do have a new representative who has been here to help support a new surgeon beginning to use the robot,” she continued.
Another of Francois’ new duties as coordinator involves facilitating a semi-monthly meeting of the entire robotics team of 17 multi-service staff members, to discuss any updates, research topics, or problems which have occurred. “Communication and teamwork is the number one key to having a successful robotics program,” she said.
Still, notwithstanding the learning curve, Francois said, “overall, it is just fantastic what the surgeons are able to do robotically. We did a robotic inguinal hernia the other day, and it took an hour and a half total room time. And when you view the 3-D image, as opposed to a two-dimensional laparascopic image, you can see small, delicate vessels, and they are much more defined,” she said.
posted by John J. Otrompke | 3:23 PM
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