Emergency Conversion Simulation

Complete three years of annual emergency conversion training.

Checklist for Surgeon Assessment During Emergency Robotic Undocking

(Bold = critical misses)

Scenario 1: Massive hemorrhage via PA bleed

• Loupes/headlight in room if desired
• Outline thoracotomy incision after patient positioning
• Identify bleeding source/suction to see bleed
• Apply manual pressure with robotic instruments
• Call for hemostatic agents
• Call for surgical support
• Discuss possible need for transfusion
• Determine need for conversion

Scenario 2: Decision to Convert to Open

• Discuss undocking plan
• Continue applying manual pressure to the bleeding vessel while bedside assistant begins thoracotomy if instructed
• Ask for lights on
• Attending surgeon scrubbed in + at bedside
• Uninterrupted visualization of bleed during conversion
• Removal of all robotic instruments without removing manual pressure
• Thoracotomy incision
• Apply manual pressure to bleeding vessel after thoracotomy
• Primarily repair PA injury

Scenario 3: Hemodynamic Instability

• Ensure bleeding has been controlled/there are no other areas of bleeding
• Discuss EBL and reasons for hemodynamic instability
• Discuss additional need for blood products and/or vasopressors
• Use closed loop communication
• Request internal paddles be set up on sterile field

Scenario 4: PEA/Asystole

• Communicate initiation of intra-thoracic cardiac massage
• Begin adequate intra-thoracic cardiac massage at a rate of 100 BPM
• Continue cardiac massage

Scenario 5: Unstable Ventricular Tachycardia/Fibrillation

• Discuss situation with Anesthesia about possible types of shock
• Continue cardiac massage
• Defibrillate at max joules with internal paddles (10J and then go up by 5)

Here is a link to the STS-created curriculum: STS Emergency Conversion Curriculum