Recommendations for Emergency Robotic Thoracic Conversions and Intraoperative Resuscitation: A Modified Delphi Consensus Study
Abstract
BACKGROUND: The purpose of this consensus is to determine essential principles and acceptable variations in emergency conversion events in robotic thoracic operations. METHODS: A modified Delphi study was performed with 21 expert robotic thoracic surgeons. A pilot round was conducted with 5 experts to test feasibility. Two rounds were conducted between July 2024 - September 2024 with 33 statements rated on 5-point Likert scales. Statements included content across 3 domains: 1. Preoperative preparation, 2. Emergency undocking and resuscitation in the lateral position, and 3. Debriefing. A consensus report was provided to panelists after round 1 and a focus group was held. Content was adjusted between rounds based on feedback from round 1 and the focus group. Consensus was defined as agreement ≥70%. RESULTS: The response rate was 100%. Consensus was achieved for all preoperative preparation and debriefing statements. 16/19 statements regarding undocking and resuscitation achieved consensus, 3 statements (9.1%) in this domain were found to have insufficient agreement at 66.7%. Essential principles that achieved consensus included: conversion indications, calling for help, initial tamponade with robotic instruments, conversion via a partial undocking protocol, uninterrupted visualization, and team communication, amongst others. CONCLUSIONS: The consensus achieved can inform protocols for emergency robotic conversion events in thoracic surgery. The points of disagreement highlight acceptable surgeon- and institution-specific variations.
