Peroperative time-motion analysis of diagnostic laparoscopy with laparoscopic ultrasonography.

BACKGROUND: Advanced technology is being introduced rapidly into laparoscopic procedures, frequently without an accurate evaluation of its functioning. In this study, standardized time-motion analysis was applied to evaluate the peroperative surgical process and the technical equipment used in 18 cases of diagnostic laparoscopy with laparoscopic ultrasonography (DLLU). METHODS: The image through the laparoscope, the ultrasonograph and an overview of the operating theatre were recorded simultaneously. The time for each phase, efficient actions (e.g. identifying lesions by inspection, making an ultrasonogram or taking a biopsy) and limiting factors (e.g. technical problems, time spent waiting) were determined, and a current standard was defined. RESULTS: Of the actions performed, 52 per cent were qualified as efficient, 17 per cent were classified as time spent waiting for personnel, instruments were positioned in 13 per cent, and unnecessary instrument exchanges were involved in 10 per cent. The evaluation led to a significant reduction in delay times and resulted in design criteria for improved biopsy instruments. The current standard was calculated from the mean time and number of actions determined for each phase. CONCLUSION: This time-motion study provided detailed insight into the peroperative process of DLLU, leading to improvements in the surgical process and instruments used. The defined current standard will enable evaluation of the learning curve and new technologies.