Haak Fabian, Müller Philip C, Kollmar Otto, Billeter Adrian T, Lavanchy Joël L, Wiencierz Andrea, Müller-Stich Beat Peter, von Strauss Und Torney Marco
Clarunis, Department of Visceral Surgery, University Digestive Health Care Center, St. Clara Hospital and University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
Department of Visceral, Transplant, Thoracic and Vascular Surgery, Division of Hepatobiliary Surgery and Visceral Transplant Surgery, University Hospital Leipzig, Leipzig , Germany.
Langenbecks Arch Surg. 2025 Mar 11;410(1):96. doi: 10.1007/s00423-025-03634-7.
Surgical process models (SPM) are simplified representations of operations and their visualization by surgical workflow management systems (SWMS), and offer a solution to enhance communication and workflow.
A 1:1 randomized controlled trial was conducted. A SPM consisting of six surgical steps was defined to represent the surgical procedure. The primary outcome, termed "deviation" measured the difference between actual and planned surgery duration. Secondary outcomes included stress levels of the operating team and complications. Analyses employed Welch t-tests and linear regression models.
18 procedures were performed with a SWMS and 18 without. The deviation showed no significant difference between the intervention and control group. Stress levels (TLX score) of the team remained largely unaffected. Duration of operation steps defined by SPM allows a classification of all liver procedures into three phases: The Start Phase (low IQR of operation time), the Main Phase (high IQR of operation time) and the End Phase (low IQR of operation time).
This study presents a novel SPM for open liver resections visualized by a SWMS. No significant reduction of deviations from planned operation time was observed with system use. Stress levels of the operation team were not influenced by the SWMS.
手术过程模型（SPM）是手术操作的简化表示形式，并通过手术工作流程管理系统（SWMS）进行可视化，为加强沟通和工作流程提供了一种解决方案。
进行了一项1:1随机对照试验。定义了一个由六个手术步骤组成的SPM来代表手术过程。主要结局指标“偏差”衡量实际手术时长与计划手术时长之间的差异。次要结局指标包括手术团队的压力水平和并发症。分析采用了韦尔奇t检验和线性回归模型。
使用SWMS进行了18例手术，未使用SWMS进行了18例手术。干预组和对照组之间的偏差无显著差异。团队的压力水平（任务负荷指数得分）基本未受影响。由SPM定义的手术步骤时长可将所有肝脏手术分为三个阶段：起始阶段（手术时间四分位间距较低）、主要阶段（手术时间四分位间距较高）和结束阶段（手术时间四分位间距较低）。
本研究提出了一种通过SWMS可视化的开放性肝切除术新型SPM。使用该系统未观察到与计划手术时间的偏差有显著减少。手术团队的压力水平不受SWMS影响。
