title: Video analysis of anticipatory movements performed by surgeons during laparoscopic procedures.
abstract: BACKGROUND
  This video-aided observational study was conducted to examine team cooperation among surgeons in a surgical team built up with different time lengths. We predicted that the surgeons in a team that has longer teamwork experience would perform more anticipatory movements than surgeons in a surgical team that is newly formed.
  
  
  METHODS
  Laparoscopic Nissen fundoplication cases were videotaped with both surgical view and the OR view. An anticipatory movement was identified when a surgeon manually provided direct assistance for an upcoming task without a request by other surgeons in the team.
  
  
  RESULTS
  A total of 28 cases of laparoscopic Nissen fundoplication were videotaped and analyzed. Fifteen operations were performed by surgeons collaborating as a team for 10 weeks, in contrast to 13 operations performed by surgeons paired up for less than 5 weeks. Significantly more anticipatory movements were performed by the surgeons in the dedicated team (22 counts) than by those in the developing team (19 counts, p = 0.029). However, the OR time was not significantly different (dedicated team = 111 min, developing team = 115 min, p = 0.611) between the two teams which suggests that other types of coordination would also influence surgical teamwork.
  
  
  CONCLUSIONS
  Working in a team allows surgeons to develop sophisticated cognition to anticipate an upcoming task and provide assistance without verbal communication. The greater number of anticipatory movements observed in the dedicated surgical team suggests that anticipatory movement can be a valuable measure for team cooperation. Further research with a larger number of cases is needed to see whether performance of more anticipatory movements does shorten OR time.
authors.affiliation: Minimally Invasive Surgery Program, Legacy Health System, Portland, OR 97210, USA. bzhengbc@hotmail.com
authors.forename: Bin
authors.initials: B
authors.lastname: Zheng
authors.forename: Lee L
authors.initials: LL
authors.lastname: Swanström
mesh_terms: D002983:Clinical Competence; D003299:Cooperative Behavior; D018662:Fundoplication / Q000379:methods*; D006379:Helping Behavior; D006801:Humans; D007400:Interprofessional Relations; D010535:Laparoscopy; D009068:Movement; D015588:Observer Variation; D010348:Patient Care Team; D011597:Psychomotor Performance; D013647:Task Performance and Analysis; D013997:Time Factors; D014741:Video Recording