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13-09-2023 | Expert Opinion | 2023 SAGES Oral

A cognitive task analysis of expert surgeons performing the robotic roux-en-y gastric bypass

Authors: Karan Grover, Daniel Praise Mowoh, Hamza Nasir Chatha, Ajitha Mallidi, Shravan Sarvepalli, Curtis Peery, Carlos Galvani, Dmytro Havaleshko, Amit Taggar, Leena Khaitan, Mujjahid Abbas

Published in: Surgical Endoscopy | Issue 12/2023

Abstract

Background

The safe and effective performance of a robotic roux-en-y gastric bypass (RRNY) requires the application of a complex body of knowledge and skills. This qualitative study aims to: (1) define the tasks, subtasks, decision points, and pitfalls in a RRNY; (2) create a framework upon which training and objective evaluation of a RRNY can be based.

Methods

Hierarchical and cognitive task analyses for a RRNY were performed using semi-structured interviews of expert bariatric surgeons to describe the thoughts and behaviors that exemplify optimal performance. Verbal data was recorded, transcribed verbatim, supplemented with literary and video resources, coded, and thematically analyzed.

Results

A conceptual framework was synthesized based on three book chapters, three articles, eight online videos, nine field observations, and interviews of four subject matter experts (SME). At the time of the interview, SME had practiced a median of 12.5 years and had completed a median of 424 RRNY cases. They estimated the number of RRNY to achieve competence and expertise were 25 cases and 237.5 cases, respectively. After four rounds of inductive analysis, 83 subtasks, 75 potential errors, 60 technical tips, and 15 decision points were identified and categorized into eight major procedural steps (pre-procedure preparation, abdominal entry & port placement, gastric pouch creation, omega loop creation, gastrojejunal anastomosis, jejunojejunal anastomosis, closure of mesenteric defects, leak test & port closure). Nine cognitive behaviors were elucidated (respect for patient-specific factors, tactical modification, adherence to core surgical principles, task completion, judicious technique & instrument selection, visuospatial awareness, team-based communication, anticipation & forward planning, finessed tissue handling).

Conclusion

This study defines the key elements that formed the basis of a conceptual framework used by expert bariatric surgeons to perform the RRNY safely and effectively. This framework has the potential to serve as foundational tool for training novices.

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Title: A cognitive task analysis of expert surgeons performing the robotic roux-en-y gastric bypass
Authors: Karan Grover
Daniel Praise Mowoh
Hamza Nasir Chatha
Ajitha Mallidi
Shravan Sarvepalli
Curtis Peery
Carlos Galvani
Dmytro Havaleshko
Amit Taggar
Leena Khaitan
Mujjahid Abbas
Publication date: 13-09-2023
Publisher: Springer US
Keywords: Expert Opinion
Expert Opinion
Published in: Surgical Endoscopy / Issue 12/2023
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-023-10354-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A cognitive task analysis of expert surgeons performing the robotic roux-en-y gastric bypass

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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