Surg Endosc (2004) 18:1597-1600 DOI: 10.1007/s00464-003-8210-1 Springer Science+Business Media, inc. 2004 and OtherInterventional Techniques Time-motion analysis of operation theater time use during laparoscopic cholecystectomy by surgical specialist residents M. H. Geryane, I G. B. Hanna, I A. Cuschieri 2 i Department of Surgery and Technology, St. Mary's Hospital, Imperial College, London, United Kingdom 2 Surgical Skills Unit, Ninewells Hospital and Medical School, University of Dundee, Dundee DDI 9SY, Scotland, United Kingdom Received: 12 April 2003/Accepted: 12 May 2004/Online publication: 11 October 2004 Abstract Background." Data on man machine interfaces in the operation theater are essential to the improvement of surgical efficiency. This study analyzed the activity of the operating team during laparoscopic cholecystectomy by surgical trainees. Methods. The endoscopic image and overview of the operating room were recorded during 20 laparoscopic cholecystectomies performed by specialist residents. Time-motion analysis of the recorded tapes was per- formed. Results: The median (interquartile range [IQR]) for theater time was 134 ~_ rain (IQR, 52 min). The com- ponents of operative time for the surgeon were 26% for insertion of access ports and wound closure, 57% for intracorporeal endoscopic work, and 17% for instrument change. Only 52% of the scrub nurse time was related to the operation. Machine and video setup, adjustment of ancillary equipment together, and delivery of instru- ments and items requested by the surgeon and scrub nurse accounted for 13% of the circulating nurse time. Conclusions: With the current nonergonomic theater design and structure, a significant proportion of theater time during routine uncomplicated laparoscopic surgery is used for nonoperative functions. The study highlights the need for improved ergonomic design, integrated bus operating systems under the control of the surgeon, and multifunctional laparoscopic instruments. Key words: Time-motion analysis ....... Laparoscopic cholecystectomy --- Theater time -- Specialist surgical residents because of lengthy waiting lists and financial constraints. Objective information on theater time use is necessary for efficient surgical performance, increased safety, and accommodation of supervised surgical operative train- ing. Efficiency entails appropriate use of manpower, facilities, and equipment to achieve the ideal operative care because operating room time constitutes a signifi- cant part of the cost for surgical treatment. This applies especially to short-stay laparoscopic surgery, (e.g., lap- aroscopic cholecystectomy [LC]), for which 60% of hospital costs are incurred while the patient is in the operating room [14]. In addition, complications often can be traced to errors that occur in the operating room. Besides increased suffering, complications add consid- erably to treatment costs. Time-motion studies examine the actions of the operating team to identify the ideal motion patterns conducive to optimal task execution. The use of motion and time study has brought many benefits to a range of industries, hence its appeal especially to the manufac- turing sector of the economy. Although less often used in health care services, it can confer similar benefits for such services, especially operative surgery, in which time-motion studies may identify unproductive activi- ties and inefficient communication between theater staff and provide information for improving operating room layout and equipment design [9]. The objectives of the current descriptive study were to analyze the use of theater time, the activity of the operating team, and the nature of instrument use during a common laparoscopic operation. Optimum management of operation theater time has become a key concern of the National Health Service CorresT)ondence to." A. Cuschieri Materials and methods Patients For this study, 20 consecutive patients with symptomatic gallstone disease were consented to participate. All the operations were per- formed in the main theater suite at Ninewells Hospital.