Surgical Flow Disturbances in Dedicated Minimally Invasive Surgery Suites: An Observational Study to Assess Its Supposed Superiority Over Conventional Suites

Abstract

Background Minimally invasive surgery (MIS) is frequently compromised by surgical flow disturbances due to technology-and equipment-related failures. Compared with MIS in a conventional cart-based OR, performing MIS in a dedicated integrated operating room (OR) is supposed to be beneficial to patient safety. The aim of this study was to compare a conventional OR with an integrated OR with regard to the incidence and effect of equipmentrelated surgical flow disturbances during an advanced laparoscopic gynecological procedure [laparoscopic hysterectomy (LH)]. Methods Using video recording, 40 LHs performed between November 2010 and April 2012 (20 in a conventional cart-based OR and 20 in an integrated OR) were analyzed by two different observers. Outcome measures were the number, duration and effect (on a seven-point ordinal scale) of the surgical flow disturbances (e.g., malfunctioning, intraoperative repositioning, setup device). Results A total of 103 h and 45 min was observed. The interobserver agreement was high (kappa .85, p \ .001). Procedure time was not significantly different (NS) [conventional OR vs. integrated OR, minutes ± standard deviation (SD), mean 161 ± 27 vs. 150 ± 34]. A total of 1651 surgical flow disturbances were observed (mean ± SD per procedure 40.8 ± 19.4 vs. 41.8 ± 15.9, NS). The mean number of surgical flow disturbances per procedure with regard to equipment was 6.3 ± 3.7 versus 8.5 ± 4.0, NS. No clinically relevant differences in the mean effect of these disturbances on the surgical flow between the two OR setups were observed. Conclusions Performing LH in an integrated OR did not reduce the number of surgical flow disturbances nor the effect of these disturbances. Furthermore, in the integrated OR, repositioning of the monitors was a frequent and timeconsuming source of disturbance. In order to maintain the high standard of surgical safety, the entire surgical team has to be aware that by performing surgery in an integrated OR different potential source for disruption arise.

Surgical phase modelling in minimal invasive surgery

“…The dataset used contains 40 cases of laparoscopic hysterectomy (LH), which were recorded between November 2010 and April 2012 in the Bronovo Hospital in The Hague, The Netherlands, for the purpose of a study on surgical flow disturbances by Blikkendaal et al [2]. The procedures were recorded using three cameras and four audio signals using an audiovisual recording system (MPEG Recorder 2.1, Noldus Information Technologies, Wageningen, The Netherlands).…”

“…The LH surgery was separated into 10 surgical phases and 36 surgical steps based on the method of perioperative analysis of surgeries by Den Boer et al [2, 13], see Table 1 for a description. The phases do not necessarily occur in a chronological order.…”

“…miscommunication). However, also equipment/instrument-related issues (malfunctioning or wrong positioned) and environmental-related problems (such as disturbances by telephone or radio) are described [2]. …”

“…If a procedure takes longer than scheduled, subsequent procedures have to be postponed or cancelled. On the other hand, when operations run short, the operating rooms are unutilised at the end of the day [2]. …”

“…Since the 1990s, a shift is seen from the traditional abdominal surgical approach to the laparoscopic or robotic one [12]. We assume this is a very suitable procedure for surgical phase recognition, due to its variability in total duration (between 98 and 214 min) [2]. The aim of this study is to find to what extent accurate phase recognition can be beneficial for long and complex procedures.…”