Department of Service Science and Operations Management, Zhejiang University, Hangzhou, China.
Division of Information Technology and Mathematical Sciences, University of South Australia, Adelaide, Australia.
Surg Endosc. 2019 Nov;33(11):3673-3687. doi: 10.1007/s00464-018-06656-z. Epub 2019 Jan 30.
Traditionally, hierarchical task analysis (HTA) in surgery examines observable disruption in a predefined set of tasks as performed, rather than examining the ergonomics requirements, which may predispose surgical teams to act erroneously. This research aims to address this gap in the literature. It develops a HTA protocol taking into consideration surgical team actions, observable external disruption, internal disruption, and ergonomic goals required for safer conducting procedures. Laparoscopic radical prostatectomy (LRP) is selected as a case.
This research involved observations inside operating rooms (ORs) of three large teaching hospitals in Australia and China. Two rounds of observations are conducted: observations for developing HTA, and observations after presenting the developed HTA among surgical teams. The traditional HTA format is expanded to include two additional columns: technical considerations and ergonomics considerations. Two groups are formed from the observed LRPs. LRPs in the first group were conducted with no regard to the specified ergonomic goals and associated ergonomic features, and the second are conducted with the surgical teams attempting to follow specified ergonomic goals and features as prescribed in HTA. Careful attempt is required to select procedures such that the total operative times for both groups are approximately equal (± 5%).
Between March 2016 and November 2017, a total of 29 LRPs were observed, and a HTA developed. The results reveal significant reduction (43%) in the total external disruptive events and approximately 58% reduction in the internal disruptive events in LRPs conducted with HTA requirements.
The developed HTA appears to have some utility, but needs evaluation in larger studies. It can potentially be used as a training aid, and as a checklist for evaluating surgical performance.
传统的手术层级任务分析（HTA）检查的是可观察到的预定任务执行过程中的中断，而不是检查可能导致手术团队犯错的人体工程学要求。本研究旨在弥补这一文献空白。该研究开发了一种 HTA 协议，其中考虑了手术团队的动作、可观察到的外部中断、内部中断以及进行手术所需的人体工程学目标。选择腹腔镜根治性前列腺切除术（LRP）作为案例。
本研究涉及澳大利亚和中国的三家大型教学医院手术室的观察。进行了两轮观察：第一轮观察用于开发 HTA，第二轮观察则是在手术团队中展示开发的 HTA 之后进行。传统的 HTA 格式扩展为包括另外两列：技术考虑和人体工程学考虑。从观察到的 LRP 中形成了两组。第一组的 LRP 没有考虑指定的人体工程学目标和相关的人体工程学特征，而第二组则试图按照 HTA 中规定的指定人体工程学目标和特征进行操作。需要仔细选择手术，以使两组的总手术时间大致相等（±5%）。
2016 年 3 月至 2017 年 11 月，共观察了 29 例 LRP，并开发了 HTA。结果显示，在按照 HTA 要求进行的 LRP 中，总外部干扰事件减少了 43%，内部干扰事件减少了约 58%。
开发的 HTA 似乎具有一定的效用，但需要在更大的研究中进行评估。它可以作为培训辅助工具，并作为评估手术表现的检查表。
