Application of rules 1 to 6 for maximizing government infrastructure utilization in laparoscopic cholecystectomy: A case series analysis

TL;DR

This paper explores a two-operation room model to increase the number of laparoscopic cholecystectomy surgeries in government hospitals in India.

Contribution

The study introduces the '1-6 rule' as a novel policy strategy to optimize surgical efficiency in resource-limited settings.

Findings

The two-operation room model significantly increased the number of surgeries completed in 6 hours compared to routine practice.

The average operative time was 24.45 minutes per case, with most patients being female and averaging 44.8 years old.

Abstract

Laparoscopic cholecystectomy (LC) is the gold standard treatment for gallstone disease, but long waiting lists are common in India
due to high disease prevalence and limited government resources. Therefore, it is of interest to evaluate a two-operation room (OR)
model to optimise resource utilisation, in which patient preparation in one OR was overlapped with surgical steps in another OR. A total
of 64 patients were operated on over three days, with an average operative time of 24.45 minutes per case; significantly more surgeries
were completed in 6 hours with the new model (21.3 cases) compared to routine practice (6.3 cases in 8 hours, p <0.05). Most patients
were female (98%), with a mean age of 44.8 years and operative times ranged from 9 to 55 minutes. The "1-6 rule" (1 consultant, 2 ORs, 3
assistants, 4 anaesthetists, 5 nursing/support staff and 6 hours of surgery) may be an innovative policy strategy for maximising LC
efficiency in government hospitals.