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A quantitative study of disruption in the operating room during laparoscopic antireflux surgery

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Many activities performed by team members in the operating room (OR) are not directly related to the achievement of the surgical goal.


A video-aided observational field study was conducted in the OR to examine disruptive events during laparoscopic antireflux surgery. Disruptive events were categorized into one of six groups: instrument change, surgeon position change, nurse duty shift, conversation, phone/pager answering, and extraneous interruption. The frequency and duration of each type of disruptive event were recorded. Events were further categorized based on whether or not they delayed the workflow.


The average procedure time of 12 observed cases was 123 min. On average, a total of 114 disruptive events were recorded per hour. Intraoperative conversations were recorded with the highest frequency (71 episodes/h) and longest duration (16 min/h); however, most conversations did not delay surgical workflow. The events that generated most surgical delays were instrument change (3.4 min/h), which included times for placing essential instruments into the surgical site and time spent waiting for an unavailable instrument. On average, disruptive events performed in the OR caused 4.1 min of delay for each case per hour, corresponding to 6.5% of the procedure time.


This study demonstrated the feasibility of using video-aided observational studies for developing objective assessment of team quality in the OR. Categorizing disruptive events and examining their negative impact on the OR time will help to develop methods to eliminate inefficiency inside the OR.

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This project was supported by the Legacy Research Advisor Committee Grant 2006 and the authors wish to thank surgeons, OR nurses, and anesthesiologists for their cooperation and contributions. Thanks are also due to Dr. Alan Lomax for his feedback and kind assistance with manuscript preparation. The authors especially want to thank the Editor as well as the two anonymous reviewers for their helpful comments.

Author information

Correspondence to Bin Zheng.

Additional information

This work was presented at the SAGES 2008 meeting. Philadelphia, PA.

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Zheng, B., Martinec, D.V., Cassera, M.A. et al. A quantitative study of disruption in the operating room during laparoscopic antireflux surgery. Surg Endosc 22, 2171–2177 (2008).

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  • Workflow
  • OR efficiency
  • Disruption
  • Laparoscopic procedure
  • Video analysis
  • Team assessment