[Workflow analysis to assess the efficiency of intraoperative technology using the example of functional endoscopic...

Evaluation of the efficiency of surgical technology systems has to date been largely subjective. The aim of this study was to develop an ontology for surgical procedures usable workflow structures, and the evaluation of surgical workflow analysis using the example of functional endoscopic sinus surgery (FESS). A total of 38 procedures (20 patients) were included. Surgery was carried out by seven different surgeons with different degrees of training. Description of the surgical procedures and resources is based on the standard EN1828/2001 (Structure for Classification and Coding Systems for Surgical Procedures). In addition the requirements of the Workflow Reference Models (document no. Tc00-1003), Workflow Management Coalition (WfMC) were integrated. The workflow recorded the position, frequency of change of position, use time, cleaning time and concept based instrument changes. A total of 293 items were used to define FESS. A total of 1,029 different endoscopic positions were documented. These could be combined into five major endoscopic positions. The frequency of position changes was 27.1 per side, the period spent in an endoscopic position is about 1.31 min. Time for the concept-caused instrument changing was 6.44 min per side. This study demonstrates the need for assistance in guiding the endoscope in FESS. Using the workflow-data, the concept of an assistant system is possible. We offer a basis for discussion of the development of an ontology, recording and analysing surgical workflows and their practical application.