M H Geryane1, G B Hanna, A Cuschieri. 1. Department of Surgery and Technology, St. Mary's Hospital, Imperial College, London, United Kingdom.
Abstract
BACKGROUND: Data on man-machine interfaces in the operation theater are essential to the improvement of surgical efficiency. This study analyzed the activity of the operating team during laparoscopic cholecystectomy by surgical trainees. METHODS: The endoscopic image and overview of the operating room were recorded during 20 laparoscopic cholecystectomies performed by specialist residents. Time-motion analysis of the recorded tapes was performed. RESULTS: The median (interquartile range [IQR]) for theater time was 134 +/- min (IQR, 52 min). The components of operative time for the surgeon were 26% for insertion of access ports and wound closure, 57% for intracorporeal endoscopic work, and 17% for instrument change. Only 52% of the scrub nurse time was related to the operation. Machine and video setup, adjustment of ancillary equipment together, and delivery of instruments and items requested by the surgeon and scrub nurse accounted for 13% of the circulating nurse time. CONCLUSIONS: With the current nonergonomic theater design and structure, a significant proportion of theater time during routine uncomplicated laparoscopic surgery is used for nonoperative functions. The study highlights the need for improved ergonomic design, integrated bus operating systems under the control of the surgeon, and multifunctional laparoscopic instruments.
BACKGROUND: Data on man-machine interfaces in the operation theater are essential to the improvement of surgical efficiency. This study analyzed the activity of the operating team during laparoscopic cholecystectomy by surgical trainees. METHODS: The endoscopic image and overview of the operating room were recorded during 20 laparoscopic cholecystectomies performed by specialist residents. Time-motion analysis of the recorded tapes was performed. RESULTS: The median (interquartile range [IQR]) for theater time was 134 +/- min (IQR, 52 min). The components of operative time for the surgeon were 26% for insertion of access ports and wound closure, 57% for intracorporeal endoscopic work, and 17% for instrument change. Only 52% of the scrub nurse time was related to the operation. Machine and video setup, adjustment of ancillary equipment together, and delivery of instruments and items requested by the surgeon and scrub nurse accounted for 13% of the circulating nurse time. CONCLUSIONS: With the current nonergonomic theater design and structure, a significant proportion of theater time during routine uncomplicated laparoscopic surgery is used for nonoperative functions. The study highlights the need for improved ergonomic design, integrated bus operating systems under the control of the surgeon, and multifunctional laparoscopic instruments.
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