Resuscitation during robotic-assisted pelvic surgery: impact of simulation training and system-specific factors

Intraoperative cardiac arrest during robotic-assisted surgery is rare but poses challenges due to limited patient access and the need for undocking. Evidence on structured team training and system-specific factors affecting time to cardiopulmonary resuscitation (CPR) remains limited. This prospective single-center simulation study evaluated six multidisciplinary teams managing standardized cardiac arrest scenarios with the daVinci® and HugoRAS® system. Teams completed three simulations: an unannounced baseline scenario, a second scenario following structured debriefing and introduction of a standardized emergency flowchart, and a third scenario after 3–5 months to assess skill retention. Primary endpoint was time to CPR initiation. Secondary endpoints were protocol adherence and undocking time. Repeated training significantly reduced time to CPR (58.2 ± 26.2 s vs. 31.8 ± 8.9 s; p = 0.03) and improved compliance with the emergency flowchart (p = 0.03). While overall time to CPR initiation did not differ between robotic systems (daVinci®: 48.0 ± 23.5 vs. HugoRAS®: 43.2 ± 16.1, p = 0.6), undocking time was significantly shorter with the daVinci® compared to the HugoRAS® system (20.8 ± 2.4 s vs. 41.0 ± 7.5 s; p < 0.001). Undocking phase accounted for 48.9 ± 14.0% of the time leading up to the CPR in DaVinci® and 69.8 ± 13.1% in HugoRAS®. Simulation-based multidisciplinary team training may improve resuscitation performance during robotic-assisted surgery. Undocking was the main source of delay with system-specific differences. Standardized emergency protocols and regular simulation training should be implemented to enhance patient safety in robotic operating rooms.