Blom E M, Verdaasdonk E G G, Stassen L P S, Stassen H G, Wieringa P A, Dankelman J
Department of BioMechanical Engineering, Delft University of Technology, Mekelweg 2, 2628, CD, Delft, The Netherlands.
Surg Endosc. 2007 Sep;21(9):1560-6. doi: 10.1007/s00464-006-9161-0. Epub 2007 Feb 7.
Verbal communication in the operating room during surgical procedures affects team performance, reflects individual skills, and is related to the complexity of the operation process. During the procedural training of surgeons (residents), feedback and guidance is given through verbal communication. A classification method based on structural analysis of the contents was developed to analyze verbal communication. This study aimed to evaluate whether a classification method for the contents of verbal communication in the operating room could provide insight into the teaching processes.
Eight laparoscopic cholecystectomies were videotaped. Two entire cholecystectomies and the dissection phase of six additional procedures were analyzed by categorization of the communication in terms of type (4 categories: commanding, explaining, questioning, and miscellaneous) and content (9 categories: operation method, location, direction, instrument handling, visualization, anatomy and pathology, general, private, undefinable). The operation was divided into six phases: start, dissection, clipping, separating, control, closing.
Classification of the communication during two entire procedures showed that each phase of the operation was dominated by different kinds of communication. A high percentage of explaining anatomy and pathology was found throughout the whole procedure except for the control and closing phases. In the dissection phases, 60% of verbal communication concerned explaining. These explaining communication events were divided as follows: 27% operation method, 19% anatomy and pathology, 25% location (positioning of the instrument-tissue interaction), 15% direction (direction of tissue manipulation), 11% instrument handling, and 3% other nonclassified instructions.
The proposed classification method is feasible for analyzing verbal communication during surgical procedures. Communication content objectively reflects the interaction between surgeon and resident. This information can potentially be used to specify training needs, and may contribute to the evaluation of different training methods.
手术过程中手术室的言语交流影响团队表现，反映个人技能，并与手术过程的复杂性相关。在外科医生（住院医师）的程序训练期间，通过言语交流给予反馈和指导。开发了一种基于内容结构分析的分类方法来分析言语交流。本研究旨在评估手术室言语交流内容的分类方法是否能深入了解教学过程。
对八例腹腔镜胆囊切除术进行录像。通过根据类型（4类：指令、解释、提问和其他）和内容（9类：手术方法、位置、方向、器械操作、可视化、解剖与病理、一般、私人、无法定义）对交流进行分类，分析了两例完整的胆囊切除术以及另外六例手术的解剖阶段。手术分为六个阶段：开始、解剖、夹闭、分离、控制、关闭。
对两例完整手术过程中的交流进行分类显示，手术的每个阶段都以不同类型的交流为主导。除控制和关闭阶段外，在整个手术过程中都发现了高比例的解释解剖与病理的交流。在解剖阶段，60%的言语交流是解释性的。这些解释性交流事件分类如下：27%为手术方法，19%为解剖与病理，25%为位置（器械与组织相互作用的定位），15%为方向（组织操作的方向），11%为器械操作，3%为其他未分类的指令。
所提出的分类方法对于分析手术过程中的言语交流是可行的。交流内容客观地反映了外科医生与住院医师之间的互动。这些信息可能用于明确培训需求，并可能有助于评估不同的培训方法。
