Standardization of operative technique in minimally invasive right hepatectomy: improving cost-value relationship through value stream mapping in hepatobiliary surgery

Jajja, Mohammad Raheel; Maxwell, Daniel W.; Hashmi, Satwat; Meltzer, Rebecca S.; Lee, Edward; Sweeney, John F.; Sarmiento, Juan M.

doi:10.1016/j.hpb.2018.09.012

Cited by 6 publications

(4 citation statements)

References 26 publications

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“…Recognizing and temporally localizing these tasks allows for process surgical modelling and workflow analysis [9]. This further facilitates the current trend in MIS practice towards establishing standardized protocols for surgical workflow and guidelines for task execution, describing optimal tool positioning with respect to the anatomy, setting performance benchmarks, and ensuring operational safety and complication-free, cost-effective procedures [10, 11]. The ability to objectively quantify surgical performance could impact many aspects of the user and patient experience, like a reduced mental/physical load, increased safety, and more efficient training and planning [12, 13].…”

Section: Surgical Process Understandingmentioning

confidence: 99%

Computer Vision in the Surgical Operating Room

et al. 2020

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Background: Multiple types of surgical cameras are used in modern surgical practice and provide a rich visual signal that is used by surgeons to visualize the clinical site and make clinical decisions. This signal can also be used by artificial intelligence (AI) methods to provide support in identifying instruments, structures, or activities both in real-time during procedures and postoperatively for analytics and understanding of surgical processes. Summary: In this paper, we provide a succinct perspective on the use of AI and especially computer vision to power solutions for the surgical operating room (OR). The synergy between data availability and technical advances in computational power and AI methodology has led to rapid developments in the field and promising advances. Key Messages: With the increasing availability of surgical video sources and the convergence of technologiesaround video storage, processing, and understanding, we believe clinical solutions and products leveraging vision are going to become an important component of modern surgical capabilities. However, both technical and clinical challenges remain to be overcome to efficiently make use of vision-based approaches into the clinic.

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Section: Surgical Process Understandingmentioning

confidence: 99%

Computer Vision in the Surgical Operating Room

et al. 2020

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“…The authors have previously demonstrated that MIRH has superior clinical outcomes compared to ORH [16][17][18]. This study reveals that while a selection bias may exist, the often quoted radiographic and pathologic features suggestive of a challenging procedure were not significant factors in determining operative difficulty in MIRH.…”

Section: No Association Between Complexity and Parenchymal Featuresmentioning

confidence: 63%

Unravelling the Complexity Myth for Minimally Invasive Right Hepatectomy: Liver Parenchymal Features and their Correlation to Objective Outcomes in Major Anatomical Resections

et al. 2021

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Background Minimally invasive approaches to major liver resection have been limited by presumed difficulty of the operation. While some concerns arise from mastering the techniques, factors such as tumor size and liver parenchymal features have anecdotally been described as surrogates for operative difficulty. These factors have not been systematically studied for minimally invasive right hepatectomy (MIRH). Methods Seventy‐five patients who underwent MIRH during 2007–2016 by the senior author were evaluated; these were compared to control group of open right hepatectomy. Demographics, operative, and post‐operative variables were collected. Operative times and estimated blood loss, two objective parameters of operative difficulty were correlated to volume of hepatic resection, parenchymal transection diameter and liver parenchymal features using regression analysis. Results Thirty‐eight (50.6%) resections were performed for malignant indications. Average tumor size was 5.7 cm (±3.6), mean operative time was 196 min (±74), and mean EBL was 220 mL (±170). Average transection diameter was 10.1 cm (±1.7). There was no correlation between operative difficulty with parenchymal transection diameter or presence of steatosis. Blood loss was higher with increased right hepatic lobe volume and body mass index. Conclusions This analysis of a very defined anatomical resection suggests that the often quoted radiographic and pathologic features indicative of a challenging procedure were not significant in determining operative difficulty.

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“…The approach to hepatectomy has been previously reported. 9 The approach to incisional ventral hernia repairs (IVHR) was determined by the operating hernia surgeon and the HPB surgeon did not participate planning or repair of IVH. With the exception of complex abdominal wall reconstructions (CAWR), all LVHR and OVHR were performed with intraperitoneal placement of mesh with fascial overlap of 5.0-cm with suture or absorbable tacks, under decreased intraperitoneal pressure of approximately 10.0 mmHg.…”

Section: Operative Techniquementioning

confidence: 99%

“…Recent publications have demonstrated that a standardized approach to laparoscopic right hepatectomy can decrease perioperative costs and improve post-operative outcomes,. 8,9 However, despite recent evolution of laparoscopic hepatic resection techniques, the role of ORH remains a necessity for complicated or high risk operations. While LRHs are typically performed through right subcostal or upper-midline incisions for hand-assist access or specimen retrieval, ORHs may also be approached via other openaccess approaches including right subcostal chevron, hockey stick, and "Mercedes Benz" incisions e adding to the heterogeneity of incisional hernia occurrences in this patient population.…”

Section: Introductionmentioning

confidence: 99%