Last June, the Augusta Health Board of Directors—fifteen local representatives from Staunton, Augusta County and Waynesboro—voted to expand the surgical options for patients at Augusta Health with the addition of a da Vinci Xi Surgical System. This decision would provide the community with the latest and most advanced robotic technology available.
By the end of October, the first robotic surgery at Augusta Health was performed by urologist Brian Stisser, MD. By the end of February, the Robotic Surgery Program had expanded it service to include urology, colorectal, gynecology and general surgery procedures.
Between June and October, though, much behind-the-scenes work needed to be completed to bring the da Vinci Xi Surgical System on-line—including forming a surgical team, building instrumentation trays, developing an educational plan and organizing the operating room to function as needed. Coordinating and managing these logistics was the responsibility of a team of surgical nurses led by Vickie Taylor, BSN MS, Administrative Director of Surgical Services & Women's Health at Augusta Health.
"When we have a new technology like robotic surgery, the first step is to build the team, and once we have a team, to build an Education Plan," explained Vickie. She actually planned for three rotating teams—each with a scrub nurse, first assistant scrub, and a circulator—to support the surgeons and a service line coordinator to keep everything organized. As it turned out, recruiting for the team was relatively easy. She sent out an email to Surgical Nursing, asking who would be interested in serving on the Robotic Surgery Team and had more than enough response from qualified staff. Erin Coffey, BSN RN, was selected a Robotic Service Line Lead.
"As the Service Line lead, I work closely with the physicians and suppliers to make sure we have everything we need for each surgery," said Erin. "Since each surgeon might want the Operating Room set up a bit differently, I also keep track of individual preferences to keep everything running smoothly."
Other team members volunteered to be a part of the new technology, a direction they all see as the future of surgery. One member, Meredith Brown, had a more personal motivation. Several years ago, her father in Atlanta had prostate cancer removed robotically, so she knew first-hand the benefits to the patient. "I wanted to be a part of that here," she said.
Another challenge to operationalizing the Robotic Surgery Program was education and credentialing. "Since the Xi system was a new technology for the area, there was no local educational option," explained Vickie. "So first, each team member was required to complete eight to ten hours of online educational modules, tailored for his or her role. After all the online training was completed, we had a full-day on-site training with the vendor, Intuit. This was on a Saturday about two weeks before we went live, and was very hands-on with our robot." In addition, the surgical team (circulator and scrub nurse) who performed the first case observed cases at Virginia Commonwealth University prior to 'go-live' at Augusta Health. The first assistant surgical team members were also required to attend a "pig lab" offsite with a physician.
This first team supported the first few surgeries at Augusta Health, and then they served as preceptors to train the other two three-member teams. This method of training ensured quality and safety to the patients; to be sure all team members were credentialed, competent and efficient. To date, they have supported Augusta Health surgeons on more than 70 cases.
Robotic Surgery is different, they all agree, but in ways that are amazing and enjoyably challenging. First, the physician is not in the surgical field, but a bit away at a console, so the nurses are closer to the patient, and more easily understand what is happening and anticipate the needs of both the patient and the surgeon. The visibility is improved because of the high-definition images provided by the camera, and the movement of the instruments 'far surpasses' anything they've experienced before with open and laparoscopic surgeries. And the robot, quite frankly, is just pretty cool and amazing itself.
The greatest reward of being on the Robotic Surgery team, though, has been the benefits to their patients. Because the incisions are smaller and more precise, there are fewer complications like infections and blood loss, and shorter hospital stays with faster recovery time and return to normal activities. So most importantly, their patients get to go home quicker, which is something they've learned all patients universally desire.
They all take great pride in their team—'even more than the new technology, the opportunity to work with and collaborate with this team is the best part of the job'—and in bringing this technology to their community. They agree: "We can take care of patients right here. They don't have to travel for robotic surgery. We are right here in their community and they know us. We will take care of them."
Augusta Health's Robotic Surgery Nursing Team
- Vickie Taylor, BSN MS, Administrative Director of Surgical Services & Women's Health
- Erin Coffey, BSN RN, Robotic Service Line Lead
- Nicole Arave, CST, Robotic Service Surgical Tech
- Meredith Brown, BSN RN, Robotic Service Circulator and Thoracic Service Line Lead
- Sean Daly, CST, Robotic Service Surgical Tech
- Michelle Insana, CST, Robotic Service Surgical Tech
- Kenny Moss, RN, Robotic Service Circulator
- Mary Spangler, LPN, Robotic Service Assistant
- Martha Kennedy, BSN RN, Robotic Service Assistant
Originally published in the News Virginian/Daily Progress Salute to Nurses Section on May 7, 2017.