Importance of a proper planning of surgical procedures in pediatric laparoscopy. Theater checklist.

Aims: Ergonomics and proper planning of surgical procedures are the basis of success for laparoscopy in children. The successful execution of a laparoscopic procedure requires a great familiarity with the equipment and the positioning of the operators. This is to avoid unnecessary surgical team fatigue that affects the duration and effectiveness of the intervention. We conducted a study on our laparoscopic procedures to determine the effectiveness and usefulness of the application of ergonomics and a regular use of a preoperative checklist. Materials and Methods: We studied the laparoscopic operations performed by a single operator between January 2008 and July 2011. These factors were considered: the position and orientation of equipment, crew and patient discomfort, and the problems encountered by the operators. We used as evaluation criteria the diagrams proposed by Lenoir and Steinbrecher and an appropriate preoperative checklist. Results: Of the 49 measures considered, only 22 procedures were useful and met the evaluation criteria. No correlation, referring to the physical measures, were detected in operations lasting <60 minutes. The fatigue of the operating team grew, even if non-exponentially, after the first hour of operation. In the 22 procedures considered, there were 71 "adverse" episodes that delayed or complicated the procedure; most of these were related to inadequate preparation of the operating room, instruments, or operators (malfunction of synthesis equipment, unavailability of instruments, insufficient number of principals, malposition of trocars, or unavailability of image intensifier). After the adoption of checklist, verified in the subsequent 18 procedures, only 10 adverse episodes occurred. Conclusions: Our study seems to confirm that simple steps related to proper planning of laparoscopic procedures were directly linked to the effectiveness of surgical performance and duration of the intervention. The preoperative checklist we set, in our experience, resulted as very useful in preventing intra-operative problems. Keywords: Ergonomics, Checklist, Laparoscopy, Children