Hierarchical decomposition of laparoscopic surgery: a human factors approach to investigating the operating room environment

Hierarchical decomposition of complex behaviour and systems is a valuable r esearch methodology from human factors and information-processing psycholog y that can be applied to laparoscopic surgery. This article describes resul ts of research on surgeons performing several different laparoscopic proced ures, conducted in Vancouver, Canada 1995-98. Through top-down analyses of surgical procedures and bottom-up analyses of tool motions, results include d detailed decomposition of the procedures through surgical steps, sub-step s, tasks, sub-tasks and tool motions. Analyses at all levels provided valua ble information. In addition to specific surgeon- and technology-related ob servations, such as the effect of dividing the short gastrics on performanc e of Nissen fundoplication, gaze patterns of surgeons and factors related t o patient safety were analysed. The hierarchical decomposition approach can be extended to other aspects of the complex system that consists of the su rgeon and operating room team, the technologies and the operating room envi ronment. Other frameworks for assessment are also considered.