The benefits of electrosurgery have been acknowledged since the early 1920s, and nowadays more than 80% of surgical procedures involve devices that apply energy to tissues. Despite its widespread use, it is currently unknown how the operator's choices with regard to instrument selection and application technique are related to complications. As such, the manner in which electrosurgery is applied can have a serious influence on the outcome of the procedure and the well-being of patients. The aim of this study is to investigate the variety of differences in usage of electrosurgical devices. Our approach is to measure these parameters to provide insight into application techniques. A sensor was developed that records the magnitude of electric current delivered to an electrosurgical device at a frequency of 10 Hz. The sensor is able to detect device activation times and a reliable estimate of the power-level settings. Data were recorded for 91 laparoscopic cholecystectomies performed by different surgeons and residents. Results of the current measurement data show differences in the way electrosurgery is applied by surgeons and residents during a laparoscopic cholecystectomy. Variations are seen in the number of activations, the activation time, and the approach for removal of the gallbladder. Analysis showed that experienced surgeons have a longer activation time than residents (3.01 vs 1.41 seconds, P <.001) and a lower number of activations (102 vs 123). This method offers the opportunity to relate application techniques to clinical outcome and to provide input for the development of a best practice model.

Efficiency in the Operating Room (OR) is a topic of growing interest. Planning of care is a crucial element to ensure optimal use of the ORs. Currently, OR scheduling is considered as a complex task based on predictions of surgery duration. The latter are often based on average times, but turn out to be inaccurate in practice because of various factors (such as complexity, patient's characteristics, unexpected events, etc). The aim of this study is to develop a prediction system that estimates in real-time the remaining duration of a surgical procedure. The prediction system was based on monitoring the progress of a procedure by recording the activation of a single piece of equipment in the OR, the electrosurgical device. Support Vector Machines was then used as a classifier to predict the remaining surgical procedure duration and thereby the optimal timing to start preparing the next patient for surgery. The classifier was trained with data on the activation of the electrosurgical device during 55 laparoscopic cholecystectomies. The performance tests showed a mean error rate about 0.2, which means that about 80% of the procedures were classified correctly. The real-time prediction system is a promising tool to improve OR planning and decrease unnecessary patients' waiting times.