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Detecting performance variance in complex surgical procedures: analysis of a step-wise technique for laparoscopic right hepatectomy.
Toro, Juan P; Patel, Ankit D; Lytle, Nathaniel W; Sweeney, John F; Medbery, Rachel L; Scott Davis, Steven; Lin, Edward; Sarmiento, Juan M.
Afiliación
  • Toro JP; Department of Surgery, Emory Endosurgery and HPB Surgery Units, Emory University, Atlanta, GA, USA.
  • Patel AD; Department of Surgery, Emory Endosurgery and HPB Surgery Units, Emory University, Atlanta, GA, USA.
  • Lytle NW; Department of Surgery, Emory Endosurgery and HPB Surgery Units, Emory University, Atlanta, GA, USA.
  • Sweeney JF; Department of Surgery, Emory Endosurgery and HPB Surgery Units, Emory University, Atlanta, GA, USA.
  • Medbery RL; Department of Surgery, Emory Endosurgery and HPB Surgery Units, Emory University, Atlanta, GA, USA.
  • Scott Davis S; Department of Surgery, Emory Endosurgery and HPB Surgery Units, Emory University, Atlanta, GA, USA.
  • Lin E; Department of Surgery, Emory Endosurgery and HPB Surgery Units, Emory University, Atlanta, GA, USA.
  • Sarmiento JM; Department of Surgery, Emory Endosurgery and HPB Surgery Units, Emory University, Atlanta, GA, USA. Electronic address: jsarmie@emory.edu.
Am J Surg ; 209(2): 418-23, 2015 Feb.
Article en En | MEDLINE | ID: mdl-25682098
BACKGROUND: Laparoscopic right hepatectomy (LRH) is a technically challenging operation. Our aim is to evaluate a standardized technique of LRH and determine variances in performance. METHODS: The procedure was deconstructed into 7 major step-wise components. All LRH followed the same surgical sequence, and used the same devices and operating room set-up. Thirty randomly selected video recordings of the procedure underwent intraoperative time analysis. The variances measured by standard deviation of each step were calculated (mean in minutes ± standard deviation). RESULTS: Mean total operative time was 114 ± 25 min. The steps with the least variance were inferior vena cava dissection (8 ± 3) and right hepatic vein ligation (9 ± 5). The longest and also the step with the greatest variance was parenchymal transection (35 ± 12). CONCLUSIONS: LRH can be performed consistently using a standardized step-wise technique. Parenchymal transection had most variation, and this could be explained by intrinsic liver factors. Surgical performance improvement should begin with deconstructing the operation into definable steps to identify areas for change.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Pautas de la Práctica en Medicina / Laparoscopía / Hepatectomía Tipo de estudio: Observational_studies / Prognostic_studies Límite: Humans Idioma: En Revista: Am J Surg Año: 2015 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Pautas de la Práctica en Medicina / Laparoscopía / Hepatectomía Tipo de estudio: Observational_studies / Prognostic_studies Límite: Humans Idioma: En Revista: Am J Surg Año: 2015 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos