Exploring the effects of closed-console vs. open-console robotic-assisted surgery systems on team dynamics in the operating room.

Using the input-mediator-output-input framework, this study aims to explore the effects of closed-console and open-console robotic-assisted surgery (RAS) systems on team dynamics in the operating room. RAS has been rapidly evolving, with several systems available on the market and in clinical use. While these RAS systems have distinct features and designs, the main distinction that impacts team dynamics during surgery is the console design. We conducted 10 semi-structured interviews with operating room team members who had experience using either or both of the RAS systems. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis. Participants reported better vision across the operating room and higher situational awareness in the open-console system than in the closed-console system. They also reported feeling the operating surgeon's presence and approachability more in the open-console system, whereas they tried not to disturb the surgeon in the closed-console system. Moreover, they reported being able to use more nonverbal cues and gestures in the open-console system than in the closed-console system. The console design was found to have little effect on coordination, but participants reported that compared with the closed console, the open console allowed the operating surgeon to see any issues at the bedside more quickly and provide assistance earlier. This study provides empirical evidence that the open-console system improves team dynamics in the operating room, reducing delays and enhancing operation efficiency. It offers guidance for RAS system selection, training, and optimizing team processes.