High volume, quick turnover day-case robotic cholecystectomy utilising the HIT principle: a service evaluation for driving increased productivity.

With waiting lists for elective surgery at an all-time high in the NHS, achieving safe, effective and efficient surgery has become paramount. "HIT lists" (high intensity theatre lists) have gained popularity and have successfully been implemented in institutions within the NHS to improve productivity across specialties with a view to achieving waiting list reduction. Achieving efficiency through meticulous planning and parallel processing has been shown to be effective in urology but has yet to be reported in the context of (robotic) general surgery. With 75,000 cholecystectomies performed in the UK on an annual basis, the issue of high throughput for this procedure is of particular relevance. Here, we report the successful application of HIT principles in the context of an NHS hospital, for the first time using a single team and a single theatre, performing up to 10 robotic cholecystectomies during a standard working day and hereafter being referred to as an "stHIT list". We increased theatre utilisation by up to 100% with a significant potential overall increase in income in the context of a tariff-based reimbursement framework compared to a standard 5 case laparoscopic list.