title: Surgical flow disturbances in dedicated minimally invasive surgery suites: an observational study to assess its supposed superiority over conventional suites.
abstract: Minimally invasive surgery (MIS) is frequently compromised by surgical flow disturbances due to technology- and equipment-related failures. Compared with MIS in a conventional cart-based OR, performing MIS in a dedicated integrated operating room (OR) is supposed to be beneficial to patient safety. The aim of this study was to compare a conventional OR with an integrated OR with regard to the incidence and effect of equipment-related surgical flow disturbances during an advanced laparoscopic gynecological procedure [laparoscopic hysterectomy (LH)].
  
  
  
  Using video recording, 40 LHs performed between November 2010 and April 2012 (20 in a conventional cart-based OR and 20 in an integrated OR) were analyzed by two different observers. Outcome measures were the number, duration and effect (on a seven-point ordinal scale) of the surgical flow disturbances (e.g., malfunctioning, intraoperative repositioning, setup device).
  
  
  
  A total of 103 h and 45 min was observed. The interobserver agreement was high (kappa .85, p < .001). Procedure time was not significantly different (NS) [conventional OR vs. integrated OR, minutes ± standard deviation (SD), mean 161 ± 27 vs. 150 ± 34]. A total of 1651 surgical flow disturbances were observed (mean ± SD per procedure 40.8 ± 19.4 vs. 41.8 ± 15.9, NS). The mean number of surgical flow disturbances per procedure with regard to equipment was 6.3 ± 3.7 versus 8.5 ± 4.0, NS. No clinically relevant differences in the mean effect of these disturbances on the surgical flow between the two OR setups were observed.
  
  
  
  Performing LH in an integrated OR did not reduce the number of surgical flow disturbances nor the effect of these disturbances. Furthermore, in the integrated OR, repositioning of the monitors was a frequent and time-consuming source of disturbance. In order to maintain the high standard of surgical safety, the entire surgical team has to be aware that by performing surgery in an integrated OR different potential source for disruption arise.
authors.affiliation: Department of Gynecology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.
authors.forename: Mathijs D
authors.initials: MD
authors.lastname: Blikkendaal
authors.affiliation: Department of Gynecology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.
authors.forename: Sara R C
authors.initials: SR
authors.lastname: Driessen
authors.affiliation: Department of Gynecology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.
authors.forename: Sharon P
authors.initials: SP
authors.lastname: Rodrigues
authors.affiliation: Department of Gynecology, Bronovo Hospital, PO Box 96900, 2509 JH, The Hague, The Netherlands.
authors.forename: Johann P T
authors.initials: JP
authors.lastname: Rhemrev
authors.affiliation: Department of Gynecology, Bronovo Hospital, PO Box 96900, 2509 JH, The Hague, The Netherlands.
authors.forename: Maddy J G H
authors.initials: MJ
authors.lastname: Smeets
authors.affiliation: Department of BioMechanical Engineering, Technical University Delft, Mekelweg 2, 2628 CD, Delft, The Netherlands.
authors.forename: Jenny
authors.initials: J
authors.lastname: Dankelman
authors.affiliation: Department of BioMechanical Engineering, Technical University Delft, Mekelweg 2, 2628 CD, Delft, The Netherlands.
authors.forename: John J
authors.initials: JJ
authors.lastname: van den Dobbelsteen
authors.affiliation: Department of Gynecology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands. f.w.jansen@lumc.nl.|Department of BioMechanical Engineering, Technical University Delft, Mekelweg 2, 2628 CD, Delft, The Netherlands. f.w.jansen@lumc.nl.
authors.forename: Frank Willem
authors.initials: FW
authors.lastname: Jansen
mesh_terms: D000328:Adult; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007044:Hysterectomy; D010535:Laparoscopy; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009426:Netherlands; D009873:Operating Rooms / Q000458:organization & administration*; D011446:Prospective Studies; D014741:Video Recording; D057188:Workflow
keywords: Integrated operating room; Minimally invasive surgery; Patient safety; Surgical flow disturbances; Technical equipment; Video observation