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Robotic surgery: a day in the life of the UK’s first robotic nursing fellow

Providing cutting-edge care is just part of the attraction, alongside advanced skills and holistic care

Providing cutting-edge care is just part of the attraction for Marie Taniacao, alongside advanced skills, multidisciplinary teamwork and holistic care

In 2019, Marie Taniacao became the first robotic nursing fellow at the Royal Marsden NHS Foundation Trust in London, one of the worlds leading cancer centres.

The fellowship the first hospital-based fellowship scheme of its kind in the UK is designed to equip theatre nurses with the advanced knowledge and skills required to assist not only surgeons carrying out robotic operations, but in other surgical specialties too.

Masters degree in surgical care practice

After completing the Royal College of Surgeons-accredited training, Ms Taniacao will gain a

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Providing cutting-edge care is just part of the attraction for Marie Taniacao, alongside advanced skills, multidisciplinary teamwork and holistic care

Marie Taniacao with the da Vinci Xi robotic surgical system
Marie Taniacao with the da Vinci Xi robotic surgical system

In 2019, Marie Taniacao became the first robotic nursing fellow at the Royal Marsden NHS Foundation Trust in London, one of the world’s leading cancer centres.

The fellowship – the first hospital-based fellowship scheme of its kind in the UK – is designed to equip theatre nurses with the advanced knowledge and skills required to assist not only surgeons carrying out robotic operations, but in other surgical specialties too.

Master’s degree in surgical care practice

After completing the Royal College of Surgeons-accredited training, Ms Taniacao will gain a master’s degree in surgical care practice, specialising in gynaecological, upper gastrointestinal and colorectal surgery. On completion, she will have a similar level of responsibility in theatre to that of a junior doctor.

Here, she takes us through a typical day at work.

Planning for the the busy day – and week – ahead

5.45am I leave home and travel by train to work. It’s quite early, but I try to arrive with plenty of time, particularly with COVID-19 travel restrictions and safety protocols in place. Also, with fewer passengers travelling at this time of the morning, I can avoid crowded carriages.

6.45-7:00am I arrive at the Royal Marsden Hospital in west London and prepare to head to theatres. Before I start work, I make sure I have breakfast. I check my emails and read through the list of patients coming in for surgery – not only for that day, but up to a week in advance. I regularly check this to be aware of every upcoming surgery and each patient’s profile, as this allows me to better understand my responsibilities and organise myself so I can provide the highest standard of care and quality treatment.

7.30am My first appointment is in day surgery, where I conduct a preoperative visit with patients who have been prepared for surgery. I welcome them, reconfirm their consent with the gynaecology team, and answer any questions they may have. My aim is to make sure they feel as settled and comfortable as possible before their surgery. If a patient feels particularly anxious, I or a member of the gynaecology team will sit and talk with them, to offer reassurance.

High quality care comes from effective team work

8.05am Theatre huddle starts at 8am, followed by a team briefing inside theatres with the gynaecology team. During these sessions we will be joined by the anaesthetists, anaesthetic practitioner and scrub team. We discuss the structure of the day, patients’ medical conditions, the planned surgery and any specific treatment that may be needed, and equipment requirements. I communicate with the anaesthetic and scrub teams, making sure everyone is informed and fully understands all of our requirements. This means that we can treat patients effectively and safely as a team, and provide the best standard of care.

Working closely as a multidisciplinary team allows us to build strong working relations with one another. Every team member is so supportive of what we all do, and it feels great to be a part of this team and form a bond both inside and outside the operating theatres.

8.15am After the briefing, I take part in ward or critical care unit (CCU) rounds to review our postoperative patients. This includes physical examinations – abdominal and wound assessments - requesting their bloods, checking over their results, and reviewing imaging and documentation.

8.45am We start operating in theatres, where I will be for four to six hours. The surgery ranges from minor cases, such as a diagnostic laparoscopy or examination under anaesthesia, to major cases, such as a pelvic exenteration (where some of the organs of the pelvis are removed). We classify ‘minor cases’ as surgeries that can be completed within an hour; ‘intermediate cases’ are those of between one and three hours; and ‘major’ or ‘complex cases’ are procedures that last three or more hours.

‘In this role, I’m more involved than I have been before in every aspect of our patients’ care, and get to know them a lot better’

Minor and intermediate cases will be undertaken one after the other, with a short pause after each procedure to complete the necessary documentation, transfer the patient to the recovery ward and ensure they are safe, and then prepare the next patient for surgery.

In my role, I assist in medical examinations, anaesthetics, diagnostics and laparoscopic and robotic procedures. This covers a lot of different tasks – for example, I carry out urinary catheter insertions, port preparations and insertions, camera manipulation, suctioning and retractions, internal examinations using a speculum, or manual examinations with the supervision of my clinical supervisor, senior fellow or registrar.

I also dock and undock the da Vinci Xi robot, our robotic surgical system, and provide the patient with bedside assistance while the consultant and fellow are operating via the robot’s console. Essentially, I make sure that that the equipment is positioned in the correct way throughout surgery and that everything is available for the surgeons to use.

My experience within gynaecological surgeries means I can accurately anticipate these requirements because I have developed an awareness and understanding of what the surgeon needs during the procedure and when.

3.30pm Half-hour lunch break.

4pm Return to theatres with my team to complete the surgeries scheduled for that day.

Contact with patients throughout the care pathway

6pm For minor and intermediate procedures we usually finish around 6-6.30pm. This is followed by a final ward round to visit the patients we have treated that day. We talk to them, explain how the procedure went, check on how they are feeling and answer any questions they may have. Again, my aim is to make sure they feel comfortable, safe and reassured.

One special part of working at the Royal Marsden is that it’s clear that we don’t just focus our efforts on treating cancer, but on understanding each individual patient’s needs and concerns, and supporting them throughout. It really makes such a difference.

7pm I change out of my scrubs and personal protective equipment and end the day by completing my documentation. This allows me to review the day’s activities and reflect on how well I performed. It’s an extra opportunity for me to work on my fellowship studies and complete paperwork related to my practice. I’m especially thankful to the Royal Marsden Cancer Charity, which has provided me with such a wonderful opportunity to develop my skillset and expertise through the robotic nursing fellowship. This in turn has allowed me to continue to improve the quality and standard of care that I deliver to our patients.

I really enjoy my role, as it allows me to be more involved than I have been before in every aspect of our patients’ care, and get to know them a lot better. I find being able to follow and support patients throughout their treatment pathways and see the positive outcomes of our work highly rewarding.


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