Objective: Complex laparoscopic surgery requires collaboration between surgeons and the surgical team. It is important for surgeons to share surgical information and perform tasks cooperatively among team members. The project examined anticipatory movements between surgeons that provided direct mutual support during laparoscopic Nissen Fundoplications. We predicted surgeons who have more experience with a surgical team would have a higher number of anticipatory momements.
Methods: A total of 18 cases of laparoscopic Nissen Fundoplication were videotaped in the operating room (OR) with both surgical site and OR room view. Eleven cases were performed by surgeons who had been cooperated in performing the procedure over 10 weeks (dedicated team). The other seven cases were performed by surgeons paired up less than 5 weeks (developing team). All videotapes were reviewed by a human factors researcher. Anticipatory movements were defined as a surgeon's activities that provided direct assistance to the ongoing or upcoming surgical task without instructions or requests from the other surgeon. Examples of anticipatory movements were placing trocar, retracting tissue from the surgical site, maneuvering of the laparoscope, sucking bleeding, and cutting sutures. In addition, OR time was measured from the injection of local anesthetic for inserting the Veress needle to the closure of trocar wounds.
Results: During surgeries, surgeons performed most tasks following verbal instructions or requests from their partners. The chance for performing anticipatory movements was associated with surgeons' team experience. Significantly more anticipatory movements were performed by surgeons in the dedicated team (24.4 +/- 2.8) than the developing team (17.9 +/- 5.2, p = 0.003). The OR time was not significantly different (p = 0.630) between the dedicated and developing team; however, the dedicated team did have a shorter OR time (102.0 +/- 10.8 min) on average than the developing team (105.1 +/- 13.1 min).
Conclusion: Surgical team dynamics are complex but can be assessed even in complicated surgeries like laparoscopic fundoplication. A higher number of anticipatory movements observed in the dedicated surgical team suggest that anticipatory movement is a valuable measure for team cooperation. Further research with a larger number of cases is needed to see whether performing of more anticipatory movements does shorten OR time.