Table 1.

Studies included in the systematic review

Reference	Problem addressed	Intervention Implementation (S: suggested, E: evaluated)	Intervention category	Intervention details	Intervention challenges
Ahmad [25]	Impact of workspace congestion on workflow during robotic-assisted surgery	S	Environment	Redesigning the operating room layout	Proposed interventions may only be applicable to some specialties/ may only be ideal for only certain OR types
Ahmed [37]	“Assess potential hazards in robotic-assisted urological surgery”	S	Checklist	A 22-item checklist was developed after analysis of systemic-level issues using the Healthcare Failure Mode and Effects Analysis	n/a
Allers [38]	“Interruptions during robotic-assisted surgery”	S	Environment	Redesigning the operating room layout and providing training to surgical team members	n/a
Catchpole [14]	Safety and efficiency during robotic-assisted surgery	S	Workflow	Improving system-level issues such as communication, coordination, and training	n/a
Collins [29]	The need for a proficiency-based standardized curriculum that includes both technical and non-technical training	S	Training	Simulation training for non-technical skills and team training	n/a
Craven [39]	Upper limb ergonomic strain of the surgeon on console	S	Ergonomics	Ergonomic modifications to the console workstation and posture	Ergonomic modifications may not withstand the duration of the procedure and may not be applicable for all surgeons
Dru [40]	Identification of flow disruptions that can lead to patient harm, surgical inefficiency, frustrations, communication breakdown, and longer operating times	S	Training	Technical and non-technical simulation training for surgical team members	n/a
Franasiak [41]	Ergonomic positioning of the surgeon at the console	E	Training	Training on ergonomic modifications to the console workstation and posture	Reports of strain are subjective
Jain [8]	Flow disruptions during robotic-assisted surgery	S	Training, Briefings	Teamwork training, preoperative briefings, and improvement of equipment maintenance and use	n/a
Jing [33]	Effectiveness of a checklist for robotic-assisted radical prostatectomies	E	Checklist	Implementation of a checklist for robotic-assisted prostatectomies	n/a
McCarroll [34]	Evaluate the effectiveness of a checklist for robotic-assisted gynecological procedures	E	Checklist	Implementation of a computerized checklist for robotic-assisted surgery	OR staff members were not as motivated to use the checklist if a specific nurse was not present, potentially resulting in a pseudo-Hawthorne effect
Myklebust [42]	Assess the technical/non-technical elements of teamwork that enhance efficiency and flow, and patient safety	S	Training, Checklist	Simulation-based team training, checklists, and team leader designation during robotic-assisted surgery	n/a
Raheem [43]	Communication during robotic-assisted surgery	S	Communication, Training	Standardized communication system to improve exchange of information	n/a
Randell [44]	“Integration of robotic-assisted surgery into routine practice”	S	Environment, Teamwork, Training	Operating room staff engagement, training, and operating room setup	n/a
Schiff [45]	“Quality of communication and surgical outcomes in robotic-assisted surgery”	S	Communication, Teamwork	A systematic approach to introducing inexperienced operating room staff into robotic-assisted surgery	n/a
Schuessler [46]	Assess the non-technical aspects of robotic-assisted surgery that contributes to improved patient and system outcomes	S	Training	Team-focused training to improve the practice of robotic-assisted surgery	n/a
Sexton [47]	Investigate the impact of anticipation as a measure of efficiency in robotic-assisted surgery	S	Teamwork	Develop an understanding of team dynamics and familiarity to improve team efficiency during robotic-assisted surgery	n/a
Song [48]	Complications and obstacles that occur during RAS	Ea	Checklist	Development of a checklist to improve patient safety during robotic-assisted surgery	n/a
Souders [49]	Identify flow disruptions that contribute to decreased efficiency, errors, and suboptimal patient outcomes	S	Environment	Modification to the operating room setup for robotic-assisted abdominal sacrocolpopexy surgeries to improve efficiency	n/a
Tiferes [50]	Team communication during robotic-assisted surgery	S	Communication	Improve team communication through nonverbal actions and usability testing of surgical equipment	n/a
Tiferes [10]	The gap in literature addressing the analysis of team activities during robotic-assisted surgery	S	Teamwork, Environment	Modification to the operating room setup for robotic-assisted surgery to improve safety and team efficiency	n/a
Tsafrir [51]	Quality of verbal and auditory communication in a robotic operating room	E	Technology	Evaluation of wireless audio headsets in a robotic operating room to improve the quality of communication	Ambient noise levels are not eliminated because the headset covers one ear
Van’t Hullenaar [52]	Ergonomic positioning of the first assistant during robotic-assisted surgery	S	Ergonomics	Implementation of ergonomic modifications for the first assistant during robotic-assisted surgery	n/a
Van’t Hullenaar [53]	Address possible deficiencies in training when optimizing the ergonomics and positioning of the surgeon	E	Training	Development of an ergonomic training program to provide instructions for ergonomic setup of the robotic console	Optimal interpretation and accuracy of the ergonomic setup are not guaranteed
Wastler [54]	“Communication and patient safety during robotic-assisted surgery”	S	Checklist	Development of a checklist to improve “patient safety during robotic-assisted surgery”	n/a
Weber [55]	Effect of flow disruptions on workload and performance	S	Training	Implementation of team training and strategies to improve nonverbal communication, situational awareness, and team coordination	n/a
Weigl [56]	Severity and impact of flow disruptions on the perception of teamwork	S	Communication. Teamwork, Environment	Improving system-level issues such as communication, coordination, operating room setup and management and training	n/a
Yu [11]	Assess ergonomics and workload for the first assistant and surgeon on console	S	Technology	Introduce wearable intraoperative motion tracking sensors to identify ergonomic risks in the operating room during robotic-assisted surgery	A trained researcher is required to analyze motion tracking data and sensors are not able to “differentiate whether musculoskeletal efforts of static posture are demanding or not”
Zattoni [57]	Non-technical errors during the conversion of robot-assisted to open radical prostatectomy	E	Guidelines	Development of guidelines for conversion from robotic-assisted radical prostatectomy to open radical prostatectomy	The guidelines were developed for a specific type of surgery and may not account for other surgical complications and patient factors
Zattoni [58]	Evaluate the impact of training and checklists on improving teamwork during open conversion from robotic-assisted partial nephrectomy	E	Training	Evaluation of a standardized training and institutional checklist on improving teamwork during complications requiring open conversion from robotic-assisted partial nephrectomy	The simulated environment produces shorter conversion times and may not accurately represent real-life experiences during robotic-assisted surgery

^aEvaluation of intervention was discussed, but no data were presented