Perioperative Nursing Role in Robotic Surgery: An Integrative Review

Published:February 06, 2023DOI:



      Robotic surgery is an increasingly popular approach across surgical specialties in several countries. Nurses embedded in this highly-technological environment, however, could excessively center their attention to the robot, deviating their focus from the patient. The Perioperative Patient Focused Model is proposed as a theoretical framework to guide nursing perioperative care towards a patient-centered approach based upon 4 dimensions: Health System, Safety, Behavioral Responses and Physiological Responses. This review aimed to understand the role of perioperative nursing in robotic surgery according to the Perioperative Patient Focused Model.


      An integrative review.


      The Whittemore and Knafl methodology guided this review. The following databases were searched: PubMed, Cochrane Library, ProQuest, Scielo, and LILACS. The keywords used were “Robotic Surgical Procedures” and “Nursing” and their equivalents in Spanish, Portuguese, and French, using the Boolean operator “AND,” within the time frame of 2010-2021.


      A total of 1,695 articles were retrieved, of which 26 were retained for the final analysis. The majority (n = 17) were written in English, with a level of evidence between 4 and 5. The main actions performed by nursing professionals were retrieved in the Health Systems, Safety, and Behavioral Responses dimensions, focusing on the intraoperative and postoperative period. However, most of the patient's responses were presented in the postoperative stage, even after discharge. Encompassing these findings, a theoretical framework is proposed.


      Nursing professional duties are diverse within the course of robotic surgery. It is necessary to expand the Perioperative Nursing specialty towards an extended care, encompassing even the community settings.


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        • Maza G
        • Sharma A.
        Past, present, and future of robotic surgery.
        Otolaryngol Clin North Am. 2020; 53: 935-941
        • An L
        • Hwang KS
        • Park S-H
        • et al.
        Trends of robotic-assisted surgery for thyroid, colorectal, stomach and hepatopancreaticobiliary cancer: 10 year Korea trend investigation.
        Asian J Surg. 2021; 44: 199-205
        • Sano D
        • Shimizu A
        • Tateya I
        • et al.
        Treatment outcomes of transoral robotic and non-robotic surgeries to treat oropharyngeal, hypopharyngeal, and supraglottic squamous cell carcinoma: A multi-center retrospective observational study in Japan.
        Auris Nasus Larynx. 2021; 48: 502-510
        • Lee NJ
        • Boddapati V
        • Mathew J
        • et al.
        Does robot-assisted spine surgery for multi-level lumbar fusion achieve better patient-reported outcomes than free-hand techniques?.
        Interdiscip Neurosurg. 2021; 25101213
        • Finegersh A
        • Voora RS
        • Panuganti B
        • et al.
        Robotic surgery may improve overall survival for T1 and T2 tumors of the hypopharynx: An NCDB cohort study.
        Oral Oncol. 2021; 121105440
        • Chaar M El
        • King K
        • Salem JF
        • Arishi AA
        • Galvez A
        • Stoltzfus J
        Robotic surgery results in better outcomes following Roux-en-Y gastric bypass: metabolic and bariatric surgery accreditation and quality improvement program analysis for the years 2015–2018.
        Surg Obes Relat Dis. 2021; 17: 694-700
        • Morgan S
        • Yoder LH.
        A concept analysis of person-centered care.
        J Holist Nurs. 2012; 30: 6-15
        • Öhlén J
        • Reimer-Kirkham S
        • Astle B
        • et al.
        Person-centred care dialectics—Inquired in the context of palliative care.
        Nurs Philos. 2017; 18: e12177
        • Guler E
        • Ozer MA
        • Bati AH
        • et al.
        Patient-centered oncosurgical planning with cancer models in subspecialty education.
        Surg Oncol. 2021; 37101537
        • Timmermans S
        • Yang A
        • Gardner M
        • et al.
        Does patient-centered care change genital surgery decisions? The strategic use of clinical uncertainty in disorders of sex development clinics.
        J Health Soc Behav. 2018; 59: 520-535
        • Fitzgerald J
        • Siddique M
        • Miranne JM
        • Saunders P
        • Gutman R.
        Development of a patient-centered pelvic floor complication scale.
        Female Pelvic Med Reconstr Surg. 2020; 26: 244-248
        • Tumin D.
        Patient-centered interventions and the need for patient-centered outcomes.
        Prog Transplant. 2020; 30: 75
        • Moore L
        • Britten N
        • Lydahl D
        • Naldemirci Ö
        • Elam M
        • Wolf A.
        Barriers and facilitators to the implementation of person-centred care in different health care contexts.
        Scand J Caring Sci. 2017; 31: 662-673
        • Jun E-Y
        • Oh H.
        Patient needs and satisfaction with nursing care after day surgery based on a patient-centered care framework.
        Clin Nurs Res. 2017; 26: 301-317
        • Martins RC
        • Trevilato DD
        • Jost MT
        • Caregnato RCA.
        Nursing performance in robotic surgeries: integrative review.
        Rev Bras Enferm. 2019; 72: 795-800
        • Van Wicklin SA.
        The perioperative patient focused model: A literature review.
        Perioper Care Oper Room Manag. 2020; 18100083
        • Hopia H
        • Latvala E
        • Liimatainen L.
        Reviewing the methodology of an integrative review.
        Scand J Caring Sci. 2016; 30: 662-669
        • Whittemore R
        • Knafl K.
        The integrative review: updated methodology.
        J Adv Nurs. 2005; 52: 546-553
        • Dixon-Woods M
        • Cavers D
        • Agarwal S
        • et al.
        Conducting a critical interpretive synthesis of the literature on access to health care by vulnerable groups.
        BMC Med Res Methodol. 2006; : 35
        • Silva AL
        • Teixeira HJ
        • Teixeira MJC
        • Freitas S.
        The needs of informal caregivers of elderly people living at home: An integrative review.
        Scand J Caring Sci. 2013; 27: 792-803
        • Schuessler Z
        • Stiles AS
        • Mancuso P.
        Perceptions and experiences of perioperative nurses and nurse anaesthetists in robotic-assisted surgery.
        J Clin Nurs. 2020; : 60-74
        • Gillespie BM
        • Gillespie J
        • Boorman RJ
        • Granqvist K
        • Stranne J
        • Erichsen-Andersson A.
        The impact of robotic-assisted surgery on team performance: a systematic mixed studies review.
        Hum Factors. 2020; : 1-29
        • Uslu Y
        • Altınbaş Y
        • Özercan T
        • Van Giersbergen MY.
        The process of nurse adaptation to robotic surgery: a qualitative study.
        Int J Med Robot Comput Assist Surg. 2019; : e1996
        • McBride KE
        • Steffens D
        • Duncan K
        • Bannon PG
        • Solomon MJ.
        Knowledge and attitudes of theatre staff prior to the implementation of robotic-assisted surgery in the public sector.
        PLoS One. 2019; 14e0213840
        • Wang C
        • Song Z
        • Li S
        • Tai S.
        Extended nursing for the recovery of urinary functions and quality of life after robot-assisted laparoscopic radical prostatectomy: a randomized controlled trial.
        Support Care Cancer. 2018; 26: 1553-1560
        • Mangham M.
        Positioning of the anaesthetised patient during robotically assisted laparoscopic surgery: perioperative staff experiences.
        J Perioper Pract. 2016; 26: 50-52
        • Brenner ZR
        • Salathiel M
        • Macey BA
        • Krenzer M.
        Postoperative care for the robotic surgery bowel resection patient.
        Gastroenterol Nurs. 2011; 34: 271-275
        • Kang MJ
        • De Gagne JC
        • Kang HS.
        Perioperative nurses’ work experience with robotic surgery: a focus group study.
        Comput Informatics Nurs. 2016; 34: 152-158
        • Herling SF
        • Palle C
        • Moeller AM
        • Thomsen T.
        The experience of robotic-assisted laparoscopic hysterectomy for women treated for early-stage endometrial cancer: a qualitative study.
        Cancer Nurs. 2016; 39: 125-133
      1. Best J, Day L, Ingram L, Musgrave B, Rushing H, Schooley B. Comparison of robotic versus standard surgical procedure on postoperative nursing care of women undergoing total abdominal hysterectomy. MEDSURG Nurs. 2014;23:414–421. Accessed November 13, 2021.

        • Hortman C
        • Chung S.
        Positioning considerations in robotic surgery.
        AORN J. 2015; 102: 434-440
        • Mathew R
        • Markey K
        • Murphy J
        • O'Brien B
        Integrative literature review examining factors affecting patient safety with robotic-assisted and laparoscopic surgeries.
        J Nurs Scholarsh. 2018; 50: 645-652
        • Wang Y
        • Liu Y
        • Han G
        • Yi B
        • Zhu S.
        The severity of postoperative complications after robotic versus laparoscopic surgery for rectal cancer: A systematic review, metaanalysis and meta-regression.
        PLoS One. 2020; 15e0239909
        • Moloney R
        • O'Brien B
        • Coffey JC
        • Coffey A
        • Murphy F.
        Patients’ perceptions after robot-assisted surgery: an integrative review.
        AORN J. 2020; 112: 133-141
        • Sarmanian JD.
        Robot-Assisted ThoracicSurgery (RATS): perioperative nursing professional development program.
        AORN J. 2015; 102: 241-253
        • Song JB
        • Vemana G
        • Mobley JM
        • Bhayani SB.
        The second “time-out”: a surgical safety checklist for lengthy robotic surgeries.
        Patient Saf Surg. 2013; 7: 19
        • De Souza B
        • Gomes de Souza MD
        • Moroni Primo C da S
        • Rezende Ortega de Barros NK
        • Gomes do Carmo T
        • Da Costa Moura A
        Lesões de pele ocasionadas por procedimento robótico versus aberto.
        Nursing (Lond). 2021; 24: 5775-5784
        • Pinto EV
        • Lunardi LS
        • Treviso P
        • De Abreu Botene DZ.
        Atuação do enfermeiro na cirurgia robótica: desafios e perspectivas.
        Rev SOBECC. 2018; 23: 43-51
        • Da Silva Angelo C
        • De Meira Pachioni CF
        • Giroud Joaquim EH
        • et al.
        Efetividade do protocolo prevenção de lesões de pele em cirurgias urológicas robóticas.
        Rev SOBECC. 2017; 22: 152-160
        • Silva Sousa C
        • Magalhaes Bispo D
        • Mirancos da Cunha AL
        Capacitação em cirurgia robótica no programa de residência em enfermagem perioperatória.
        Rev SOBECC. 2016; 21: 198-202
        • Veras RS de S
        • Sousa TV
        • Melchior LMR
        • Almeida MAR
        • Dos Santos TN
        • Moraes-Filho IM
        A atuação da enfermagem na cirurgia robótica: um relato de experiência.
        REVISA. 2020; 9: 725-730
        • Gurusamy KS
        • Samraj K
        • Fusai G
        • Davidson BR.
        Robot assistant versus human or another robot assistant in patients undergoing laparoscopic cholecystectomy.
        Cochrane Database Syst Rev. 2012; CD006578
      2. Pérez-Valero S, Cuadros-Rivera V, Torrego-Barroso N. Protocolo de actuación de enfermería quirúrgica en cirugía robótica. Index de Enfermería. 2019;28:214–218. Accessed November 24, 2021.

        • Pograjec A
        • Hubert J.
        Le rôle de l'IBODE en chirurgie robotique urologique.
        Progrès en Urol. 2019; 29: 899-903
        • Birch E
        • Van Bruwaene S
        • Everaerts W
        • et al.
        Developing and evaluating Robocare; an innovative, nurse-led robotic prostatectomy care pathway.
        Eur J Oncol Nurs. 2016; 21
      3. Institute JB. JBI levels of evidence [Internet]. 2014 Available from: Accessed October 29, 2021

        • Celik F
        • Edipoglu IS
        Evaluation of preoperative anxiety and fear of anesthesia using APAIS score.
        Eur J Med Res. 2018; 23: 41
        • Caddick J
        • Jawad S
        • Southern S
        • Majumder S.
        The power of words: sources of anxiety in patients undergoing local anaesthetic plastic surgery.
        Ann R Coll Surg Engl. 2012; 94: 94-98×13171221501267
        • Ustunel F
        • Erden S.
        Evaluation of fear of pain among surgical patients in the preoperative period.
        J Perianesth Nurs. 2022; 37: 188-193