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).