Evidence map›Paper›PMID 29785458›Full record

Trial reportSurgical endoscopy2018

High-resolution standardization reduces delay due to workflow disruptions in laparoscopic cholecystectomy.

Marco von Strauss Und Torney, Sohelia Aghlmandi, Jasmin Zeindler, Debora Nowakowski, Christian A Nebiker, Christoph Kettelhack, Rachel Rosenthal, Raoul A Droeser, Savas D Soysal, Henry Hoffmann and 1 more

Registry-linked trialAbstract readClinical Trial
PubMed Publisher
In one paragraph

Trial report in Surgical endoscopy, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03329859 (Impact of Microcomplications in Laparoscopic Surgery on Operative Time and Costs - Multimodal Strategy to Reduce Microcomplications), which is not on this map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03329859 nacompletednot on this map

Impact of Microcomplications in Laparoscopic Surgery on Operative Time and Costs - Multimodal Strategy to Reduce Microcomplications

TypeinterventionalSponsorUniversity Hospital, Basel, SwitzerlandRan2012 to 2016Enrolled39ConditionsWorkflow, Costs, Laparoscopy, CholecystectomyArmsHigh resolution standardized laparoscopic cholecystectomy
3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Use of Operative Video Technology in Surgical Education: A Systematic Review.Annals of surgery open : perspectives of surgical history, education, and clinical approaches · 2026
    Review
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Marco von Strauss Und TorneyDepartment of General and Visceral Surgery, University Hospital Basel, Basel, Switzerland. marco.vonstrauss@usb.ch.ORCID 0000-0003-1872-2397
Sohelia AghlmandiBasel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, University of Basel, Basel, Switzerland.
Jasmin ZeindlerDepartment of General and Visceral Surgery, University Hospital Basel, Basel, Switzerland.
Debora NowakowskiDepartment of General and Visceral Surgery, University Hospital Basel, Basel, Switzerland.
Christian A NebikerDepartment of General and Visceral Surgery, University Hospital Basel, Basel, Switzerland.
Christoph KettelhackDepartment of General and Visceral Surgery, University Hospital Basel, Basel, Switzerland.
Rachel RosenthalDepartment of General and Visceral Surgery, University Hospital Basel, Basel, Switzerland.
Raoul A DroeserDepartment of General and Visceral Surgery, University Hospital Basel, Basel, Switzerland.
Savas D SoysalDepartment of General and Visceral Surgery, University Hospital Basel, Basel, Switzerland.
Henry HoffmannDepartment of General and Visceral Surgery, University Hospital Basel, Basel, Switzerland.
Robert MecheraDepartment of General and Visceral Surgery, University Hospital Basel, Basel, Switzerland.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundOptimal resource utilization in high-cost environments like operating theatres is fundamental in today's cost constrained health care systems. Interruptions of the surgical workflow, i.e. microcomplications (MC), lead to prolonged procedure times and higher costs and can be indicative of surgical mistakes. Reducing MC can improve operating room efficiency and prevent intraoperative complications. We, therefore, aimed to evaluate the impact of a high-resolution standardized laparoscopic cholecystectomy protocol (HRSL) on operative time and intraoperative interruptions in a teaching hospital.

methodsHRSL consisted of a detailed stepwise protocol for the procedure, supported by a teaching video, both to be reviewed as mandatory preparation by each team member before surgery. Audio-video records of laparoscopic cholecystectomies were reviewed regarding type, frequency and duration of MC before and after implementation of HRSL.

resultsThirty-nine (20 control and 19 HRSL) audio-video records of laparoscopic cholecystectomies with a total duration of 51.36 h (28.92 pre 22.44 post) were reviewed. The majority of operations (86%) were performed by teams who had completed less than 10 procedures together previously. Communication-related interruptions and instrument changes accounted for the majority of MC. Median frequency and duration of MC were 95 events/h and 15.6 min/h, respectively, of surgery pre-intervention. With HRSL this was reduced to 76 events/h and 10.6 min/h of operating. In multivariable analysis, HRSL was an independent predictor for shorter delay and lower frequency of MC [percentage decrease 27% (95% CI 18-35%), resp. 30% (95% CI 19-40%)]. Procedure-related risk factors for the longer delay due to MC in multivariable analysis were less experience of the surgeon and intraoperative adhesiolysis.

conclusionsHRSL is effective in reducing delays due to MC in a teaching institution with limited team experience. These findings should be tested in larger potentially cluster-randomized controlled trials. The trial has been registered with clinicaltrials.gov: NCT03329859.

Indexed as

Cholecystectomy, LaparoscopicWorkflowGeneral SurgeryHumansInservice TrainingIntraoperative ComplicationsMedical ErrorsOperating RoomsOperative TimeSwitzerlandTotal Quality ManagementCostsDisruptionDuration of surgeryIntraoperative delayLaparoscopyMicrocomplicationsWorkflow

Identifiers

PMID29785458

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.