Lenoir Cliff, Steinbrecher Henrik
FT1 Surgery, St. Mary's Hospital, Isle of White, UK.
J Laparoendosc Adv Surg Tech A. 2010 Apr;20(3):281-91. doi: 10.1089/lap.2009.0226.
Laparoscopy is often carried out with personnel unfamiliar with the equipment and layout, thereby forcing the surgical team to adapt by twisting and stretching awkwardly. This can make laparoscopy more difficult and frustrating for the surgeon, potentially increasing patient risk. We carried out a short survey of laparoscopic procedures to determine when surgeons experience discomfort, and whether or not operative checklists could reduce these.
All patients undergoing laparoscopic operations by one surgeon between November 2006 and May 2007 were studied. Patients and surgeons had various physical measurements recorded, including the placement and orientation of equipment, staff and patients, any problems arising, and the discomfort of the surgical team. Scaled diagrams were drawn, outlining positions and orientation, allowing the measurement of the degree to which the surgeons twisted and stretched. Peroperative surgeon comfort levels were recorded. The ideal table height for surgery was calculated, suggestions to improve the surgeon's comfort were identified, recommendations on theater layout were produced, and sample checklists of common problems with ways of avoiding them were established.
Of 31 procedures, 10 had full data recorded for analysis. Physically demanding positions were common. There was no correlation between surgeon position and comfort for short operations (<60 minutes). Data for operative time >60 minutes was incomplete, but a definite trend to increasing discomfort with time was evident. In 10 operations, 85 problems occurred, 57 relating to theater layout. A third were avoidable repeat problems.
Simple measurements of surgeons, patients, and equipment improves staff and equipment positioning. A log of problems and discomforts in the theater ensures that preventable factors are not repeated, reducing the frustrations of laparoscopy. By planning equipment positioning and testing it, a preferred theater set-up layout can be retained for future use. Checklists would help in the smooth execution of a laparoscopic procedure.
