The impact of preventable disruption on the operative time for minimally invasive surgery

Abstract

This report demonstrates that preventable disruption caused an increase in operative time and forced surgeons and patients to endure unnecessary delay of more than 32%. Such additional time could be used to deal with the pressure of emergency cases and to reduce waiting lists for elective surgery.

Human error identification for laparoscopic surgery: Development of a motion economy perspective

“…We relied on literature on human factors, patient safety, and operating theatre techniques (Barnes, 1980;Dankanich;Karwowski and Salvendy, 2010;Meyers and Stewart, 2002;Philips, 2004;Wachter, 2012) as well as on our team's ergonomics and clinical experience to select and adapt the traditional principles. In addition, we consulted related research studies on surgery (Al-Hakim, 2011;Al-Hakim and Gong, 2012;Berguer, 1999;Etchells et al, 2003;He et al, 2013;Jaschinski et al, 1998;Manasnayakorn et al, 2009;Moorthy et al, 2005;Sevdalis et al, 2007;Stifelman et al, 2001;van Det et al, 2009;van Veelen et al, 2002;Vereczkei et al, 2004;Wiegmann et al, 2007;Wong et al, 2011;Zheng et al, 2007) to develop new areas and principles for motion economy.…”

“…However, the literature reveals that errors also commonly occur in surgical procedures performed by experienced surgeons and operative teams (Al-Hakim, 2011;Joice et al, 1998;Sevdalis et al, 2008;Wiegmann et al, 2007). EEM identifies and describes errors (e.g., using wrong instrument) but does not provide the root cause or actual circumstance that drives or forces a surgeon to act erroneously.…”

“…Research works on disruption in theatres explore high correlation between the accuracy, availability of information in patient's record and surgical disruption which, in turn, predisposes surgical team to fatigue and affect their motion and movement (Al-Hakim, 2011;Al-Hakim and Gong, 2012;Etchells et al, 2003;Sevdalis et al, 2007;Wiegmann et al, 2007). This principle requires surgeons and anaesthetists to provide adequate information before surgery (e.g., required instruments, material and medical tests, sketch of the positioning).…”

“…The new motion economy area E 'communication and team work' comprises 4 principles dealing with the availability and quality of the required information (Al-Hakim, 2011;Al-Hakim and Gong, 2012;Etchells et al, 2003;Sevdalis et al, 2007;Wiegmann et al, 2007;Wong et al, 2011), importance of satisfying surgeon requests during surgery, synchronising and coordination of the hand motion of the surgical team (He et al, 2013;Moorthy et al, 2005;Zheng et al, 2007), and the relative position of the surgical team. In total, we have 30 motion economy principles that suit surgical performance in operating theatres.…”

On surgical disruption: rating, expected operative time or actual wasted time—some comments on Gillepsieet al(2012)

“…We feel that what is required in studies such as the one reported by Gillespie et al 1 is a prospective assessment of the actual wasted time during an operation, and ideally also the effect of a disruptive event on operative time 2. We agree that higher incidence of specific disruptions will likely have a bigger impact on operative time, but the magnitude of the impact is likely to depend upon the type of disruption 3 4.…”