Department of Surgery, University of Maryland School of Medicine, Baltimore, MD 21201-1595, USA.
Surg Endosc. 2010 Jun;24(6):1240-4. doi: 10.1007/s00464-009-0753-3. Epub 2009 Dec 24.
Disruptions to surgical workflow have been correlated with an increase in surgical errors and suboptimal outcomes in patient safety measures. Yet, our ability to quantify such threats to patient safety remains inadequate. Data are needed to gauge how the laparoscopic operating room work environment, where the visual and motor axes are no longer aligned, contributes to such disruptions. We used time motion analysis techniques to measure surgeon attention during laparoscopic cholecystectomy in order to characterize disruptive events imposed by the work environment of the OR. In this investigation we identify attention disruptions as they occur in terms of the operating surgeon's gaze. We then quantify such disruptions and also seek to establish what occasioned them.
Ten laparoscopic cholecystectomy procedures were recorded with both intra- and extracorporeal cameras. The views were synchronized to produce a video that was subsequently analyzed by a single independent observer. Each time the surgeon's gaze was diverted from the operation's video display, the event was recorded via time-stamp. The reason for looking away (e.g., instrument exchange), when discernable, was also recorded and categorized. Disruptions were then reviewed and analyzed by an interdisciplinary team of surgeons and human factors experts.
Gaze disruptions were classified into one of four causal categories: instrument exchange, extracorporeal work, equipment troubleshooting, and communication. On average, 40 breaks occurred in operating surgeon attention per 15 min of operating time. The most frequent reasons for these disruptions involved instrument exchange (38%) and downward gaze for extracorporeal work (28%).
This study of laparoscopic cholecystectomy performance reveals a high gaze disruption rate in the current operating room work environment. Improvements aimed at reducing such disruptions-and thus potentially surgical error-should center on better instrument design and realigning the axis between surgeon's eye and visual display.
手术流程的中断与手术失误的增加以及患者安全措施的效果不佳有关。然而，我们衡量这些对患者安全构成的威胁的能力仍然不足。需要数据来评估腹腔镜手术室的工作环境如何对这种干扰产生影响，在这种环境中，视觉和运动轴不再对齐。我们使用时间运动分析技术来测量腹腔镜胆囊切除术期间外科医生的注意力，以描述手术室工作环境造成的干扰事件。在这项研究中，我们根据手术医生的注视来确定注意力的干扰。然后，我们对这些干扰进行量化，并试图确定引起这些干扰的原因。
记录了 10 例腹腔镜胆囊切除术，同时使用了体内和体外摄像头。将视图同步以生成视频，然后由单个独立观察者进行分析。每次外科医生的目光从手术视频显示屏上转移时，都会通过时间戳记录该事件。当可以分辨时，也会记录并分类导致目光转移的原因（例如，器械交换）。然后由外科医生和人为因素专家组成的跨学科团队对干扰进行审查和分析。
将目光干扰分为四类原因：器械交换、体外工作、设备故障排除和沟通。平均而言，每 15 分钟的手术时间会出现 40 次手术医生注意力的中断。这些干扰最常见的原因是器械交换（38%）和向下看以进行体外工作（28%）。
这项对腹腔镜胆囊切除术表现的研究揭示了当前手术室工作环境中存在高的目光干扰率。旨在减少这种干扰的改进措施——从而可能减少手术错误——应集中在更好的器械设计和重新调整外科医生眼睛和视觉显示器之间的轴线上。
