A Realist Process Evaluation of Robotic Surgery


The aim of this NIHR funded project is to understand how and in what circumstances robotic surgery produces both intended and unintended outcomes on communication, collaboration and decision making within surgical teams. This will be achieved through a process evaluation, running alongside ROLARR (RObotic versus LAparoscopic Resection for Rectal cancer), a randomised controlled trial (RCT) comparing laparoscopic and robotic rectal cancer surgery for the curative treatment of rectal cancer.

The project has three phases:

  • Phase 1: Identify and refine candidate theories concerning how robotic surgery becomes embedded into surgical practice and impacts on communication, teamwork and decision making in the operating theatre (OT) and the outcomes of surgery. This will be achieved through a review of grey literature, interviews with staff at different levels of the organisation across ten NHS hospital Trusts and documentary analysis.
  • Phase 2: A multi-site case study will be conducted across four NHS hospital Trusts (three that are participating in the trial and one that is not) to test and refine the candidate theories. Data will be collected using multiple methods including video recording of operations, structured and unstructured observation, and interviews.
  • Phase 3: Findings will be fed back to all four case sites in interactive sessions to produce actionable guidance on how to support integration of robotic surgery into surgical practice and how to ensure effective communication and teamwork when undertaking robotic surgery.

The project team: Rebecca Randell, Joanne Greenhalgh, David Jayne, John Hindmarsh, Dawn Dowding, Peter Gardner, Alwyn Kotze, Alan Pearman, Julie Croft, David Wilkinson, Andrew Long, Andrea Nelson, Gerard Perez