The pivotal role of the robotic nurse in the management of the robotic urologic surgical environment
Authors: Khalil Alice , Bruno Marisa , Spano Alessandro , Petrone Fabrizio , Ghiani Edoardo , Cosma Giuseppe , Chiacchio Giuseppe , Simone Flammia Rocco 
Published: June 2024

Introduction and Objectives

Robotic surgery has revolutionized urology. However, upfront costs, time investments and knowledge required to proficiently operate and maintain robotic equipment and supplies often make it advantageous to implement the role of dedicated robotic nurse (DN) teams. Herein, we aimed to investigate the impact of DN on operative times during robotic urological procedures.

Materials and Methods

We retrospectively identified consecutive robotic uro‐oncological procedures performed at our institution from Jan to Oct 2023. The cohort was stratified based on the presence or absence of a DN team (DN vs no‐DN). The DN team was defined as having independently managed ≥100 robotic urological procedures. Endpoints were preoperative nursing time (pre‐NT), postoperative nursing time (post‐NT), surgeon operative time (surg‐OT), and total operative time (t‐OT). Continuous variables were compared using Student's t‐test. Subgroup analyses were conducted for specific procedures: robot‐assisted radical cystectomy (RARC), radical prostatectomy (RARP), partial nephrectomy (RAPN), and radical nephrectomy (RARN).

Results

Overall, 421 procedures were included. The DN group exhibited shorter pre‐NT (13.5 vs 23.7, p < 0.001), post‐NT (12.2 vs. 15, p < 0.001), surg‐OT (117 vs. 136, p < 0.001), and t‐OT (143.2 vs. 174.9, p < 0.001) compared to the no‐DN group. Subgroup analysis revealed shorter pre‐NT in the DN group for all procedures: RARP (13.2 vs. 23.5, p < 0.001), RARC (16.4 vs. 29.2, p < 0.001), RARN (12.6 vs. 18.9, p < 0.001) and RAPN (12.7 vs. 20.8, p < 0.001). Conversely, DN group exhibited shorter post‐NT in RARP (12 vs. 15.8, p < 0.001) and RARN (12.4 vs. 15.3, p: 0.01), but not in RARC (13 vs. 15, p: 0.06) and RAPN (12.2 vs. 12.7, p: 0.4) subgroup. Similarly, DN group demonstrated shorter t‐OT in RARP (162.7 vs. 185.4, p < 0.001), but not in RARC (232.8 vs. 245, p: 0.44), RAPN (91.2 vs. 107.4, p: 0.35) and RARN (118.5 vs. 127.2, p: 0.4) subgroups. Finally, no differences in surg‐OT were recorded between the DN and non‐DN groups for any of the individual procedures (Table ; Figure ).

Comparison of time per procedures between dedicated and non‐dedicated teams.

Variables mean (SD)
RAPN group
Variables mean (SD)
RARP group
Variables mean (SD)
Overall procedures

Dedicated nurse team (86)
No dedicated nurse team (35)
p‐value
Dedicated nurse team (86)
No dedicated nurse team (35)
p‐value
Dedicated nurse team (86)
No dedicated nurse team (35)
p‐value

Preoperative nursing time
12.7 (±2.7)
20.8 (±5.9)
<0.001
Preoperative nursing time
13.2 (±3.3)
23.5 (±9.8)
<0.001
Preoperative nursing time
13.5 (±3.6)
23.7 (±9.7)
<0.001

Postoperative nursing time
12.2 (±3.7)
12.7 (±3.4)
0.4
Postoperative nursing time
12 (±4.1)
15.8 (±6.3)
<0.001
Postoperative nursing time
12.2 (±3.9)
15 (±5.6)
<0.001

Operative time
66.2 (±29.1)
73.8 (±44.4)
0.3
Operative time
137.5 (±37.2)
146.1 (±41.1)
0.18
Operative time
117 (±68)
136 (±68.8)
<0.001

Total operation time
91.2 (±30.2)
107.4 (±46.1)
0.35
Total operation time
162.7 (±37.8)
185.4 (±39.6)
<0.001
Total operation time
143.2 (±69)
174.9 (±72,1)
<0.001

Variables mean (SD)
RARC group
Variables mean (SD)
RARN group

Dedicated nurse team (86)
No dedicated nurse team (35)
p‐value
Dedicated nurse team (86)
No dedicated nurse team (35)
p‐value

Preoperative nursing time
16.4 (±4.8)
29.2 (±8.9)
<0.001
Preoperative nursing time
12.6 (±2.8)
18.9 (±4.7)
<0.001

Postoperative nursing time
13 (±3.5)
15 (±4.5)
0.06
Postoperative nursing time
12.4 (±3.9)
15.3 (±5.7)
0.01

Operative time
203.4 (±68.5)
200.8 (±69.7)
0.86
Operative time
93.5 (±38.7)
93 (±42.2)
0.9

Total operation time
232.8 (±66.4)
245 (±72.6)
0.44
Total operation time
118.5 (±38.9)
127.2 (±43.1)
0.4

Note: Bold indicates significant value.

Comparison of preoperative nursing time DN Team versus NoDN Team.

image

Conclusions

Our study suggests that the implementation of a dedicated robotic nursing team can lead to substantial reductions in overall operative time. This benefit is primarily attributed to shorter preoperative nursing times, highlighting the crucial role of the robotic nurse in optimizing the robotic surgical environment.