title: Impact quantification of the daVinci telemanipulator system on surgical workflow using resource impact profiles.
abstract: BACKGROUND
  It has yet to be determined whether surgical assist systems benefit surgical workflow. This question should be answered qualitatively and quantitatively and must be supported by evidence gathered from structured and rigorous analyses.
  
  
  METHODS
  A method is presented to quantify the benefits of the daVinci telemanipulator system to surgical workflow. Based on the modeling of surgical processes, resource impact profiles (RIPs) were generated. RIPs are statistical mean intervention courses for a sample of surgical process models that were performed using a specific surgical assist system as a resource. A total of 12 laparoscopic and 12 telemanipulator-supported Nissen fundoplications were modeled and analyzed to quantify the impact of the surgical assist system.
  
  
  RESULTS
  Few statistically significant benefits of the system to surgical workflow were found. It was found that the daVinci system is not superior to the conventional laparoscopic strategy if the surgeon follows the same workflow.
  
  
  CONCLUSIONS
  RIPs are a valuable method to estimate the impact of a surgical assist system on the surgical workflow. For the use case investigated, changes in workflow may be necessary to fully benefit from the advantages of using a telemanipulator in Nissen fundoplications. Conversely, the telemanipulator may only reach its full potential in more complex operations.
authors.affiliation: Innovation Center Computer Assisted Surgery, Universität Leipzig, Semmelweisstrasse 14, Leipzig, Germany. thomas.neumuth@iccas.de
authors.forename: T
authors.initials: T
authors.lastname: Neumuth
authors.forename: A
authors.initials: A
authors.lastname: Krauss
authors.forename: J
authors.initials: J
authors.lastname: Meixensberger
authors.forename: O J
authors.initials: OJ
authors.lastname: Muensterer
mesh_terms: D004867:Equipment Design; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation* / Q000379:methods; D008866:Microsurgery / Q000295:instrumentation* / Q000379:methods; D010043:Outcome and Process Assessment, Health Care; D012371:Robotics / Q000295:instrumentation* / Q000379:methods; D012984:Software; D013514:Surgical Procedures, Operative / Q000379:methods*; D017216:Telemedicine / Q000379:methods*; D016896:Treatment Outcome