Holland Tom K, Morris Stephen, Cutner Alfred
Department of Women's Health, University College Hospital, 250 Euston Road, London, NW1 2PB, UK.
Department of Applied Health Research, University College London, Gower Street, London, WC1E 6BT, UK.
BMC Womens Health. 2018 Jun 25;18(1):112. doi: 10.1186/s12905-018-0576-2.
Laparoscopic surgery is progressing rapidly is becoming the normal route for many abdominal operations, even for major complex surgery. The integrated laparoscopic theatre is a state-of-the-art system in which the laparoscopic equipment and multiple flat-screen monitors are permanently installed to be operational on demand inside the theatre. These expensive systems are being widely adopted, however very little research has been published regarding which features of these systems are desired by the surgeons who use them. The study objective was to assess the strength of preference for key attributes of integrated laparoscopic theatres and to compare these preferences between Gynaecologists and General surgeons.
This was an electronically distributed discrete choice experiment survey of British practicing Laparoscopic Gynaecologists and General Surgeons (Through The British Society of Gynaecology Endoscopy and The Association of Laparoscopic Surgeons of Great Britain and Ireland). An electronic survey was designed and pre-tested. This was then sent to practicing British Laparoscopic Gynaecologists and General-Surgeons. There were structured questions regarding the seven key attributes of integrated laparoscopic theatres in the standard form for a discrete choice experiment.
Questionnaires from 167 respondents were analysed. One hundred three were gynaecologists and 64 were general-surgeons. Adjustable screens for height and position was the most favoured attribute and it is 4.7 times more desirable than the next most desirable attribute, which was a wire free floor. The least desirable features were piped CO2, ceiling-mounted-screens and external-transmission-of-images.
Both groups favour adjustable screens for position and height above all the other features. These findings are in contrast with previous research, which showed that when asked to rank the attributes in order, gynaecologists chose ceiling mounted screens first and adjustable screens fourth. When asked to "trade off" attributes in the discrete choice experiment the adjustability of the screens became much more important than how the screens were mounted. With new wireless technology the benefits of a fully integrated theatre could be delivered with floor mounted systems at a considerably reduced cost. This information is important to manufacturers and purchasers of these systems in order to design cost effective ergonomic theatres that are fit for purpose.
腹腔镜手术发展迅速，正成为许多腹部手术的常规方式，甚至对于大型复杂手术也是如此。集成腹腔镜手术室是一种先进的系统，其中腹腔镜设备和多个平板显示器永久性安装，可在手术室内按需运行。这些昂贵的系统正在被广泛采用，然而，关于使用这些系统的外科医生期望这些系统具备哪些功能的研究却很少发表。研究目的是评估对集成腹腔镜手术室关键属性的偏好强度，并比较妇科医生和普通外科医生之间的这些偏好。
这是一项通过电子方式向英国执业腹腔镜妇科医生和普通外科医生（通过英国妇科内镜学会和大不列颠及爱尔兰腹腔镜外科医生协会）分发的离散选择实验调查。设计并预先测试了一项电子调查问卷。然后将其发送给英国执业腹腔镜妇科医生和普通外科医生。对于集成腹腔镜手术室的七个关键属性，以离散选择实验的标准形式设置了结构化问题。
分析了167名受访者的问卷。其中103名是妇科医生，64名是普通外科医生。屏幕高度和位置可调节是最受欢迎的属性，其受欢迎程度是第二受欢迎属性（无电线地面）的4.7倍。最不受欢迎的功能是管道输送二氧化碳、天花板安装屏幕和图像外部传输。
两组都最青睐屏幕位置和高度可调节，胜过所有其他功能。这些发现与之前的研究形成对比，之前的研究表明，当被要求按顺序对属性进行排名时，妇科医生首先选择天花板安装屏幕，可调节屏幕排在第四。在离散选择实验中当被要求“权衡”属性时，屏幕的可调节性变得比屏幕的安装方式重要得多。借助新的无线技术，完全集成的手术室的优势可以通过地面安装系统以大幅降低的成本实现。这些信息对于这些系统的制造商和购买者来说很重要，以便设计出符合人体工程学、经济高效且适用的手术室。
