Division of Information Technology and Mathematical Sciences, University of South Australia, Adelaide, Australia.
Service Science and Operations Management, Zhejiang University, Hangzhou, China.
Surg Endosc. 2017 Dec;31(12):5043-5056. doi: 10.1007/s00464-017-5568-z. Epub 2017 Apr 28.
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.
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.
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.
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.
本研究旨在探讨泌尿外科腹腔镜手术中手术野内操作流程中断（内部操作流程中断（OFD））的情况，并根据监视器位置、器械手柄高度以及手术团队成员位置等外部人体工程学环境来分析这些事件。据我们所知，这是此类研究中的首次。
在澳大利亚和中国的医院手术室中进行了真实观察和视频辅助观察的组合研究。首先进行头脑风暴会议，以确定主要的内部 OFD 事件，列出可观察到的原因、潜在的外部和潜在的人体工程学因素。然后进行了前瞻性观察研究。分析了观察者的记录和相关的内部手术领域视频记录。根据人体工程学环境的相似性对程序进行分组。
映射过程揭示了 39 种由 6 种原因引起的内部 OFD 事件。共选择了 24 个程序，并将其分为两组，每组 12 个程序。A 组在令人满意的人体工程学环境中进行，而 B 组在不满意的人体工程学环境中进行。共检测到 1178 次 OFD 事件，使总观察手术时间（2966 分钟）延长了 220 分钟（7.43%）。A 组的平均 OFD/h 小于 15，而 B 组约为 29 OFD/h。
有两个主要的潜在人体工程学因素影响外科医生的表现：非生理姿势和长时间静态姿势。在不满意的外部人体工程学环境下进行手术时，手术流程中断的延迟和数量几乎增加了一倍。在长时间的手术中，停止手术和无关的谈话等一些事件可能对外科医生的表现产生积极影响。
