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Ergonomics perspective for identifying and reducing internal operative flow disruption for laparoscopic urological surgery

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Abstract

Background

The aim of this study is to examine operative flow disruption that occurs inside the surgical field, (internal operative flow disruption (OFD)), during urological laparoscopies, and to relate those events to external ergonomics environment in terms of monitor location, level of instruments’ handles, and location of surgical team members. According to the our best knowledge, this is the first study of its kind.

Methods

A combination of real and video-aided observational study was conducted in the operating rooms at hospitals in Australia and China. Brain storming sessions were first conducted to identify the main internal OFD events, and the observable reasons, potential external, and latent ergonomic factors were listed. A prospective observational study was then conducted. The observer’s records and the related video records of internal surgical fields were analysed. Procedures were categorised into groups based on similarity in ergonomics environment.

Results

The mapping process revealed 39 types of internal OFD events resulted from six reasons. A total of 24 procedures were selected and arranged into two groups, each with twelve procedures. Group A was carried out under satisfactory ergonomics environment, while Group B was conducted under unsatisfactory ergonomics environment. A total of 1178 OFD events were detected delaying the total observed operative times (2966 min) by 220 min (7.43%). Average OFD/h in group A was less than 15, while in group B about 29 OFD/h.

Conclusion

There are two main latent ergonomics factors affecting the surgeon’s performance; non-physiological posture and long-period static posture. The delays and number of internal OFD were nearly doubled where procedures were conducted under unsatisfactory external ergonomics environment. Some events such as stopping operation and irrelevant conversations during long procedures may have a positive influence on the surgeon’s performance.

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Acknowledgement

The authors would like to acknowledge the support of Ms Mingli Yang, Director of International Affair Office at the Second Affiliated Hospital of Zhejiang University School of Medicine. The author also would like to acknowledge the participation of the urologist Dr Ming Wang for his effective participation in the preparation of OFD mapping.

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Authors and Affiliations

  1. Division of Information Technology and Mathematical Sciences, University of South Australia, Adelaide, Australia

    Latif Al-Hakim

  2. Department of Urology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China

    Jiaquan Xiao

  3. Austin Department of Surgery, University of Melbourne, Melbourne, Australia

    Shomik Sengupta

  4. Service Science and Operations Management, Zhejiang University, Hangzhou, China

    Latif Al-Hakim

Authors
  1. Latif Al-Hakim
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  2. Jiaquan Xiao
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  3. Shomik Sengupta
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Correspondence to Latif Al-Hakim.

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Disclosures

Drs Latif Al-Hakim, Jiaquan Xiao and Shomik Sengupta have no conflicts of interest or financial ties to disclose.

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Al-Hakim, L., Xiao, J. & Sengupta, S. Ergonomics perspective for identifying and reducing internal operative flow disruption for laparoscopic urological surgery. Surg Endosc 31, 5043–5056 (2017). https://doi.org/10.1007/s00464-017-5568-z

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  • DOI: https://doi.org/10.1007/s00464-017-5568-z

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