Introduction of the operating room black box in gynecology: Development of a procedural framework for total laparoscopic hysterectomy

Objectives Operating room (OR) delays due to inefficiency can result from a chain of intraoperative events including technical factors, equipment failures or unavailability, and non-technical human factors. The newly developed Operating Room Black Box (ORBB) technology can be used to capture information during surgery which can be analyzed to potentially identify the root causes of delays and inefficiencies. We aimed to develop a procedural framework for total laparoscopic hysterectomy (TLH) in order to accurately and consistently capture the essential time points that occur during this complex laparoscopic procedure. Methods A multi-disciplinary working group consisting of gynecologic surgeons, an anesthetist, an OR nurse and systems analysts collaborated to develop a procedural framework encompassing the critical steps and check points occurring during the course of a TLH. All phases of the operation were considered including pre-operative, intra-operative, and post-operative steps. Results The completed framework consists of a series of procedural steps divided into three time phases: pre-operative, intraoperative and post-operative. Consensus from the group led to the identification of 7 discrete steps during the pre-operative phase, 11 intra-operative steps and 6 post-operative steps. Conclusions The development of a standardized procedural framework for TLH is the first step towards capturing data with the ORBB technology. The analysis of the captured data will allow us to analyze the non-technical skills and team performance in the OR, and ultimately develop a multi-disciplinary operating room “playbook” that can be utilized to minimize time delays and maximize OR utilization.