Robotics specialist Arsenio Villarimo (right) leads a robotics demonstration during a cardiac update workshop at Veterans Affairs Medical Center of San Franciso on Feb. 9. The workshop was hosted by AORN San Francisco and Marin Chapter.

That's why many facilities appoint a perioperative nurse as robotic nursing coordinator to develop new education and competencies, manage robotics training and coordinate robotics procedures.

"Often these roles are established out of sheer necessity because the volume of work required to manage a robotics program can be a full-time job," said Annette Wasielewski, RN, BSN, CNOR, administrative director of minimally invasive surgery and robotics at Hackensack University Medical Center in Hackensack, N.J.

Wasielewski also chairs AORN's Minimally Invasive Surgery and Lasers Specialty Assembly (MIS/Lasers SA). Due to the increased number of healthcare facilities across the country adopting robotic technology, this SA has decided to include robotics within its scope.

"Robotics is an extension of minimally invasive surgery, but there is a lot more to robotics than doing a procedure. We think this SA will be a great group to explore the technology and address questions and concerns," she explained.

One important concern with robotics is safety. A robotic system has three stations including a console, often located outside of the sterile field, where the surgeon directs the robotic arm directly connected to the patient.

"It will likely be people outside of the sterile field who manage an emergency during a robotic procedure, so careful coordination with the entire OR team is very important," Wasielewski said.

Robotics in practiceRecognizing the safety concerns unique to robotic surgery, the Veterans Affairs Medical Center of San Francisco now takes a robotic "time out" before every robotic surgery. This robotic time out is taken after the pre-surgical time out is complete and before the robotic instrumentation has been docked.

During the robotic time out the surgeon reviews the role each member of the OR team will play in the event of an emergency, said Arsenio Villarimo, RN, a perioperative staff nurse who serves as the facility's robotic nursing coordinator.

For example, "If the surgeon has to go to an open procedure every member of the team needs to know his or her role in handling the equipment. The bed can't be moved until the robotic equipment is undocked or the patient could be put at risk" he explained.

Villarimo is part of a robotics committee the hospital established last year to give nurses and surgeons working with the facility's robotic system a chance to discuss issues and concerns.

"Having a group to talk about robotics has been so helpful. It gives us a chance to share our perspectives and even our frustrations," Villarimo noted.

He volunteered for the role of robotic nursing coordinator in 2006 when his facility first acquired a robotic system. "I'm a techno-junkie kind of guy and the new robotic system was a huge technological change for us. We needed someone to develop training and competencies to get everyone comfortable with robotic surgery," he acknowledged.

In his role as robotic nurse coordinator Villarimo holds regular trainings and robotic in-services with perioperative staff. He also coordinates regular training with the facility's sterile processing department to review special cleaning requirements for robotic instrumentation. "Since robotics covers many services, we all have to be versatile and prepared to handle a variety of surgeries and situations unique to the technology. This can be a challenge," Villarimo noted.

He and his robotics team communicate with other healthcare facilities using robotics in the San Francisco bay area. Villarimo hopes to establish a robotics networking group with these colleagues to troubleshoot issues and share best practices.

Filling a need
"It's important for perioperative professionals to share information and knowledge about robotics," stressed Wasielewski.

Because her facility at the Hackensack University Medical Center is a robotics training site, she fields a number of questions about robotics. "A lot of the questions we get are about everything that must happen before the surgery takes place," she said.

"Often we need training and implementation resources to augment vendor training materials. The MIS/Lasers SA is a wonderful forum to share these resources and have a venue for networking," said Beth Waterman-Hukari, RN, BSN, CNOR, incoming chair for the MIS/Laser SA and a perioperative nurse educator familiar with the robotics surgical system located at one of the five hospitals within Legacy Health System in Oregon and Washington.

"My goal as the incoming chair is to develop this SA as a one-stop informational resource for those who seek help with robotics or other emerging advanced technologies, such as Natural Orifice Transluminal Endoscopic Surgery (NOTES)," Waterman-Hukari stressed.

Later this month at AORN's annual Congress in Anaheim, Calif., the SA will discuss new minimally invasive procedures that could be done with robotic technology, including NOTES.

Waterman-Hukari and Wasielewski encourage anyone working with robotics to join the MIS/Lasers SA and participate in the SA's online community of practice.

To join the MIS/Lasers SA contact AORN Customer Service by calling 800-755-2676. Members of this SA can post questions and access resources by accessing the MIS/Lasers Specialty Assembly Online Community of Practice.

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