101 - Initial experience of Da Vinci Single-Port Robotic System in Thoracic Surgery

Description 1. Description of Team: Core members including: Three da Vinci SP-certified thoracic surgeons; three robotics-trained perioperative nurse specialists; two anesthesiologists who experienced in one-lung ventilation; one biomedical engineer from Intuitive Surgical
The nursing roles: A robotics coordinator nurse; A scrub nurse; A circulating nurse

2. Preparation and Planning
1.Training Protocol: Nurses are trained in dry-lab SP docking, emergency undocking skills, and instrument troubleshooting. Patient position training focuses on 60 degree lateral positioning, and scrub nurse focuses on hybrid instrument transitions.
2.Workflow

Design:
2.1 Pre-op checklist: Mandatory verification of long-shaft instruments
2.2 Time mapping: Buffer zones added for incision prep and nurse setup
2.3 Cart Positioning Blueprint: Patient-side cart was placed in a range from 2 meter area and plan a route to the table.
2.4 Supply Chain Coordination: A "SP Thoracic Car" was used to ensure surgical supplying.

3. Assessment
Baseline problems below were identified:
1. Positioning Risks: Traditional 90 degree lateral positioning may cause diaphragmatic tension.
2.Instrument Gaps: Standard robotic arms maybe insufficient for posterior mediastinum access.
3.Workflow Delays: Unstructured setup increased nurse prep time in initial simulations.

4. Implementation
Phase 1: Pre-Op: Verify long-shaft instrument availability; Position patient at 6 degree lateral with digital inclinometer
Nursing Innovations: Custom foam pads to prevent nerve compression
Phase 2: Docking: Align patient cart ipsilaterally; Install camera/instruments via single 25mm port
Nursing Innovations: Line-guided cart positioning system
Phase 3: Intra-Op: Scrub nurse manages "hybrid table"; Circulator monitors arm collision sensors
Nursing Innovation: Traffic light system for instrument handovers
Phase 4: Emergency strategies: Immediate undocking protocol; Convert to VATS if stapler malfunction
Nursing Innovations: QR-coded emergency guides on all carts
15 consecutive right-sided procedures (Dec 2023 to May 2024) were executed.
All cases completed without conversion

5. Outcome
Standard Nurse prep time was 10.9 ± 2.1 min. Incision-to-console time was 23 (16 to 29) min FBF bipolar graspers, MCI energy devices combined with hook, Cadiaere Forceps, Port Access Large were 100% used. No instrument errors occurred. Post-op VAS (48h) was 3.1 ± 0.9 EQ-5D recovery: Baseline 5.73 ± 1.03 → 2 weeks 7.60 ± 1.9 ↓ → 6 months 5.47 ± 0.74 (p < 0.05)

6. Implications for Perioperative Nursing
1.Positioning Science: 60 degree lateral positioning maximizes diaphragmatic mobility which adopted as new standard for robotic thoracics.
2.Hybrid instrument mastery: SP cases require dual expertise in robotic and conventional thoracic instruments
3.Time-Driven Resource Allocation: Buffer times validated: nurse prep time should less than 15 min, incision prep time should less than 30 min.
4.Safety Culture: Zero adverse events linked to double check protocol for instruments

Innovation Impact
1.100% device safety in 83 instrument deployments
2.Enhanced recovery with return to baseline QOL at 6 months
3.Validates nurse-driven standardization as the cornerstone of successful robotic program expansion.