Related Experiment Video
Updated: Mar 29, 2026
07:27
Robotic-assisted Left Pneumonectomy For Vanishing Lung Syndrome
Published on: January 23, 2026
476
Decreasing the Preincision Time for Pulmonary Lobectomy: The Process of Lean and Value Stream Mapping.
Robert James Cerfolio1, Brad L Steenwyk2, Caroline Watson2
1Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
The Annals of Thoracic Surgery
|November 26, 2015
Summary
Implementing lean protocols in pulmonary lobectomy significantly reduced pre-incision time and improved patient outcomes. This involved eliminating non-essential steps, leading to decreased mortality and morbidity in high-risk surgical patients.
Area of Science:
- Surgical Innovation
- Process Improvement in Healthcare
- Patient Safety
Background:
- The study aimed to assess the impact of lean methodology on surgical procedures.
- Lean principles focus on eliminating waste in processes.
Purpose of the Study:
- To evaluate the effectiveness of implementing lean protocols in pulmonary lobectomy.
- To determine if process standardization reduces pre-incision time without compromising patient safety.
Main Methods:
- Standardized "in the operating room-to-skin incision" protocols for pulmonary lobectomy.
- Patients were grouped into cohorts of 300 for sequential protocol adoption and outcome evaluation.
- Key interventions included eliminating axillary rolls, arm boards, beanbags, and reducing monitoring devices and catheters.
Main Results:
- A total of 2,206 pulmonary lobectomies were performed, 84% for cancer.
- Pre-incision time decreased from 64 to 37 minutes (p < 0.001).
- Mortality dropped from 3.2% to 0.26% (p = 0.015), and major morbidity decreased from 15.2% to 5.3% (p = 0.042).
Conclusions:
- Lean and value stream mapping can be safely applied to high-risk patient care algorithms.
- Eliminating non-value-added steps safely decreases pre-incision time in pulmonary lobectomy patients.
- Selected centers can adopt these lean-driven protocols for improved efficiency and outcomes.
