title: Advantages and Disadvantages of 1-Incision, 2-Incision, 3-Incision, and 4-Incision Laparoscopic Cholecystectomy: A Workflow Comparison Study.
abstract: A comparison of 1-port, 2-port, 3-port, and 4-port laparoscopic cholecystectomy techniques from the point of view of workflow criteria was made to both identify specific workflow components that can cause surgical disturbances and indicate good and bad practices. As a case study, laparoscopic cholecystectomies, including manual tasks and interactions within teamwork members, were video-recorded and analyzed on the basis of specially encoded workflow information. The parameters for comparison were defined as follows: surgery time, tool and hand activeness, operator's passive work, collisions, and operator interventions. It was found that 1-port cholecystectomy is the worst technique because of nonergonomic body position, technical complexity, organizational anomalies, and operational dynamism. The differences between laparoscopic techniques are closely linked to the costs of the medical procedures. Hence, knowledge about the surgical workflow can be used for both planning surgical procedures and balancing the expenses associated with surgery.
authors.affiliation: *Institute of Production Engineering, Faculty of Organization and Management, Silesian University of Technology, Zabrze †Hospital of Minimally Invasive and Reconstructive Surgery (CMR), Bielsko-Biała, Poland.
authors.forename: Joanna
authors.initials: J
authors.lastname: Bartnicka
authors.forename: Agnieszka A
authors.initials: AA
authors.lastname: Zietkiewicz
authors.forename: Grzegorz J
authors.initials: GJ
authors.lastname: Kowalski
mesh_terms: D017081:Cholecystectomy, Laparoscopic / Q000295:instrumentation / Q000379:methods*; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D061646:Operative Time; D010348:Patient Care Team; D013525:Surgical Instruments; D057188:Workflow