The optimization measures:
1) The scrub nurse should wash the hand before anesthesia, prepare the
items on the table and check the equipment, and prepare the
disinfectant. Circulating nurse place various equipment (including
laparoscope, trash can, electric knife, ultrasonic knife, etc.)
according to the type of operation. The circulating nurse prepares the
leg hanging device well first.
2) The surgeon start the procedure (the scrub nurse prepared well in
advance).
3) Anesthesiologist induces anesthesia; tow surgeon stand by, after the
patient loses consciousness, the circulating nurse undresses and poses
the patient; one surgeon catheterizes the urine, and the other one
surgeon prepare to disinfection. The disinfection of the surgical site
as soon as possible begins after catheterization and the circulating
nurse exposed the surgical site; the surgeon cooperate with the scrub
nurse or other doctors to drape the patient.
4) The surgeon and the scrub nurse cooperate to connect equipments
(electric knife, aspirator, ultrasonic knife, laparoscopic equipments,
etc.).
5) Check the patient and start the operation (start with the incision of
skin).
From December 2017 to February 2019, 96 patients in the optimized
surgical procedure group, 23 to 78 years old, 61 males and 35 females
(one 74-year-old male patient who lost dentures during tracheal
intubation and fell into the epiglottis, and the operation began after
the denture was took out, so this patient was withdrawed from the
study); 227 patients in the conventional control group, aged 202 to 76
years, 144 males and 83 females (one 65-year-old patient was difficult
to intubate the catheter. The suprapubic bladder puncture fistula
resulted in a delayed start of operation and was not included in this
study). There were no statistically significant differences between the
two groups in terms of factors such as gender, age, operative position,
and rate of intraday first operation. The two groups were comparable.
(Table 2).
The average preparation time in the optimized group from the start of
anesthesia induction to the start of operation was 11.72±0.30 minutes,
compared with 31.96±0.51 minutes in the control group, which has a
significant difference (Fig 2A). Clinically, there are some differences
in the pre-operative preparation between supine and lithotomy position.
The time of each procedure in the preparation process is also different.
Therefore, we further analyzed the time of preparation process of supine
and lithotomy group separately. The preparation time in the supine
position in the control group was 22.71± 0.49 minutes, while the time in
the optimized group was significantly lower than that in the control
group, which was 9.91 ± 0.13 minutes (p <0.0001, Fig 2B).
Then, we compared the time spent in each procedure between the optimized
supine surgery group and the corresponding control group. We found that
there was no significant difference in the time required for
catheterization,
disinfection, and draping. The time
from the end of anesthesia induction
to the start of catheterization, from the
end of catheterization to the start
of disinfection, from the end of the draping to the start of operation,
totaling 3 period of time were significantly less than the control group
(Fig 3).
The preparation time of surgery in the optimized lithotomy group was
15.83 ± 0.31 minutes, which was significantly less than the 32.49 ± 0.57
minutes of the control group (p <0.0001, Fig 2C). In the
optimized and control group of lithotomy position surgery, there was no
significant difference in time of
adjusting posture, disinfection,
urethral catheterization and draping. Whereas the time from end of
anesthesia to adjusting posture, the
end of adjusting posture to start of
disinfection, end of
disinfection to
start of urethral catheterization,
and the end of draping to the start
of operation were significant different between 2 groups, and the
optimized group was significantly shorter than the control group (Fig
4).