SURGICAL quality is influenced by structure, process, and outcome, relying not only on a surgeon’s skill but also on team communication. Studies show that surgeons often do not share preoperative plans with the entire team, unlike other high-risk professions. Methods like preoperative time-outs improve communication but can lead to information overload, necessitating a smarter approach.
A potential solution is the Surgical Procedure Model (SPM), which structures surgical workflows into quantifiable steps. When integrated into a Surgical Workflow Management System (SWMS), SPMs enhance communication and coordination during surgery.
This study assessed whether implementing an SWMS could improve intraoperative process quality in liver surgery. A novel SPM for open liver resections was developed and integrated into an SWMS to track procedures. While no significant reduction in deviation from planned operation time was observed, findings showed an average discrepancy of 20 minutes per scheduled hour, amounting to over an hour per procedure. This highlights a need for better planning to optimise efficiency.
Three surgical phases – Start, Main, and End – were identified based on step duration variability. Improved predictability in the Start and End phases could enhance planning, especially for anaesthesia coordination and intensive care unit preparations. Stratifying the Main Phase may also refine workflow predictability.
Importantly, the SWMS did not increase surgical team stress. While minor variations were observed, scrub nurses in training found the system useful, easing staff rotations without extensive briefings.
Though this study was limited by sample size and subjectivity in model development, it demonstrates the feasibility of integrating SWMS into complex surgeries. Future research should refine these models, expand their use to laparoscopic and robotic liver resections, and explore their potential in reducing complications and improving surgical efficiency.
Katie Wright, EMJ
Reference
Haak F et al. Digital standardization in liver surgery through a surgical workflow management system: A pilot randomized controlled trial. Langenbecks Arch Surg. 2025;410(1):96.
