title: Surgical workflow management schemata for cataract procedures. process model-based design and validation of workflow schemata.
abstract: OBJECTIVE
  Workflow guidance of surgical activities is a challenging task. Because of variations in patient properties and applied surgical techniques, surgical processes have a high variability. The objective of this study was the design and implementation of a surgical workflow management system (SWFMS) that can provide a robust guidance for surgical activities. We investigated how many surgical process models are needed to develop a SWFMS that can guide cataract surgeries robustly.
  
  
  METHODS
  We used 100 cases of cataract surgeries and acquired patient-individual surgical process models (iSPMs) from them. Of these, randomized subsets iSPMs were selected as learning sets to create a generic surgical process model (gSPM). These gSPMs were mapped onto workflow nets as workflow schemata to define the behavior of the SWFMS. Finally, 10 iSPMs from the disjoint set were simulated to validate the workflow schema for the surgical processes. The measurement was the successful guidance of an iSPM.
  
  
  RESULTS
  We demonstrated that a SWFMS with a workflow schema that was generated from a subset of 10 iSPMs is sufficient to guide approximately 65% of all surgical processes in the total set, and that a subset of 50 iSPMs is sufficient to guide approx. 80% of all processes.
  
  
  CONCLUSIONS
  We designed a SWFMS that is able to guide surgical activities on a detailed level. The study demonstrated that the high inter-patient variability of surgical processes can be considered by our approach.
authors.affiliation: Thomas Neumuth, University of Leipzig, Innovation Center for Computer Assisted Surgery (ICCAS), Semmelweisstr. 14, 04103 Leipzig, Germany. thomas.neumuth@medizin.uni-leipzig.de
authors.forename: T
authors.initials: T
authors.lastname: Neumuth
authors.forename: P
authors.initials: P
authors.lastname: Liebmann
authors.forename: P
authors.initials: P
authors.lastname: Wiedemann
authors.forename: J
authors.initials: J
authors.lastname: Meixensberger
mesh_terms: D002387:Cataract Extraction; D006801:Humans; D008962:Models, Theoretical; D025321:Surgery, Computer-Assisted; D018511:Systems Integration; D057188:Workflow