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Gillani M, Rupji M, Devin CL, Purvis LA, Paul Olson TJ, Jarc A, Shields MC, Liu Y, Rosen SA. Quantification of surgical workflow during robotic proctectomy. Int J Med Robot 2024; 20:e2625. [PMID: 38439215 DOI: 10.1002/rcs.2625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/15/2024] [Accepted: 02/22/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Surgical workflow assessments offer insight regarding procedure variability. We utilised an objective method to evaluate workflow during robotic proctectomy (RP). METHODS We annotated 31 RPs and used Spearman's correlation to measure the correlation of step time and step visit frequency with console time (CT) and total operative time (TOT). RESULTS Strong correlations were seen with CT and step times for inferior mesenteric vein dissection and ligation (ρ = 0.60, ρ = 0.60), lateral-to-medial splenic flexure mobilisation (SFM) (ρ = 0.63), left rectal dissection (ρ = 0.64) and mesorectal division (ρ = 0.71). CT correlated strongly with medial-to-lateral (ρ = 0.75) and supracolic SFM visit frequency (ρ = 0.65). TOT correlated strongly with initial exposure time (ρ = 0.60), and medial-to-lateral (ρ = 0.67) and supracolic SFM visit frequency (ρ = 0.65). CONCLUSION This study correlates surgical steps with CT and TOT through standardised annotation, providing an objective approach to quantify workflow.
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Affiliation(s)
- Mishal Gillani
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Manali Rupji
- Biostatistics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Courtney L Devin
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Lilia A Purvis
- Research Division, Intuitive Surgical, Norcross, Georgia, USA
| | - Terrah J Paul Olson
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Anthony Jarc
- Research Division, Intuitive Surgical, Norcross, Georgia, USA
| | | | - Yuan Liu
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Seth A Rosen
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
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Devin CL, Gillani M, Shields MC, Eldredge K, Kucera W, Rupji M, Purvis LA, Paul Olson TJ, Liu Y, Jarc A, Rosen SA. Ratio of Economy of Motion: A New Objective Performance Indicator to Assign Consoles During Dual-Console Robotic Proctectomy. Am Surg 2023:31348231161767. [PMID: 36898676 DOI: 10.1177/00031348231161767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
BACKGROUND Our group investigates objective performance indicators (OPIs) to analyze robotic colorectal surgery. Analyses of OPI data are difficult in dual-console procedures (DCPs) as there is currently no reliable, efficient, or scalable technique to assign console-specific OPIs during a DCP. We developed and validated a novel metric to assign tasks to appropriate surgeons during DCPs. METHODS A colorectal surgeon and fellow reviewed 21 unedited, dual-console proctectomy videos with no information to identify the operating surgeons. The reviewers watched a small number of random tasks and assigned "attending" or "trainee" to each task. Based on this sampling, the remainder of task assignments for each procedure was extrapolated. In parallel, we applied our newly developed OPI, ratio of economy of motion (rEOM), to assign consoles. Results from the 2 methods were compared. RESULTS A total of 1811 individual surgical tasks were recorded during 21 proctectomy videos. A median of 6.5 random tasks (137 total) were reviewed during each video, and the remainder of task assignments were extrapolated based on the 7.6% of tasks audited. The task assignment agreement was 91.2% for video review vs rEOM, with rEOM providing ground truth. It took 2.5 hours to manually review video and assign tasks. Ratio of economy of motion task assignment was immediately available based on OPI recordings and automated calculation. DISCUSSION We developed and validated rEOM as an accurate, efficient, and scalable OPI to assign individual surgical tasks to appropriate surgeons during DCPs. This new resource will be useful to everyone involved in OPI research across all surgical specialties.
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Affiliation(s)
- Courtney L Devin
- Department of Surgery, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Mishal Gillani
- Department of Surgery, 12239Emory University School of Medicine, Atlanta, GA, USA
| | | | - Kyle Eldredge
- Department of Surgery, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Walter Kucera
- Department of Surgery, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Manali Rupji
- Biostatistics Shared Resource, Winship Cancer Institute, 1371Emory University, Atlanta, GA, USA
| | - Lilia A Purvis
- Research Division, 19727Intuitive Surgical, Norcross, GA, USA
| | | | - Yuan Liu
- Biostatistics Shared Resource, Winship Cancer Institute, 1371Emory University, Atlanta, GA, USA.,Department of Biostatistics and Bioinformatics, Rollins School of Public Health, 1371Emory University, Atlanta, GA, USA
| | - Anthony Jarc
- Research Division, 19727Intuitive Surgical, Norcross, GA, USA
| | - Seth A Rosen
- Department of Surgery, 12239Emory University School of Medicine, Atlanta, GA, USA
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Adachi-Mejia AM, Longacre MR, Skatrud-Mickelson M, Li Z, Purvis LA, Titus LJ, Beach ML, Dalton MA. Variation in access to sugar-sweetened beverages in vending machines across rural, town and urban high schools. Public Health 2013; 127:485-91. [PMID: 23498924 PMCID: PMC3749240 DOI: 10.1016/j.puhe.2013.01.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Revised: 10/05/2012] [Accepted: 01/29/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The 2010 Dietary Guidelines for Americans include reducing consumption of sugar-sweetened beverages. Among the many possible routes of access for youth, school vending machines provide ready availability of sugar-sweetened beverages. The purpose of this study was to determine variation in high school student access to sugar-sweetened beverages through vending machines by geographic location - urban, town or rural - and to offer an approach for analysing school vending machine content. STUDY DESIGN Cross-sectional observational study. METHODS Between October 2007 and May 2008, trained coders recorded beverage vending machine content and machine-front advertising in 113 machines across 26 schools in New Hampshire and Vermont, USA. RESULTS Compared with town schools, urban schools were significantly less likely to offer sugar-sweetened beverages (P = 0.002). Rural schools also offered more sugar-sweetened beverages than urban schools, but this difference was not significant. Advertisements for sugar-sweetened beverages were highly prevalent in town schools. CONCLUSIONS High school students have ready access to sugar-sweetened beverages through their school vending machines. Town schools offer the highest risk of exposure; school vending machines located in towns offer up to twice as much access to sugar-sweetened beverages in both content and advertising compared with urban locations. Variation by geographic region suggests that healthier environments are possible and some schools can lead as inspirational role models.
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Affiliation(s)
- A M Adachi-Mejia
- Department of Pediatrics, The Geisel School of Medicine at Dartmouth, Lebanon, NH 03756-0001, USA.
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