In hospitals, the duration of surgical procedures vary even when the same procedure is performed. Surgical end-time of the procedure is currently predicted using historical data about similar procedures, the procedure time and sometimes an indication of the operating surgeon is also taken into account. After the start of the procedure, there is no documented communication between the operating room (OR) planner and the surgical team inside the OR. When the procedure is finished, a nurse has to call to inform that the next patient can be prepared for surgery. If an update of the progress of the procedure is needed, there has to be communication between the staff outside the OR and the surgical team inside the OR. To lower the workload and reduce the distractions for the surgical staff, the communication needs to be automated. This can be done by developing a support system that communicates the progress of the procedure in the OR automatically to the staff outside the OR without the need for human interaction. In this study, automatically communicating the progress of the procedure is realized by introducing a radio frequency identification (RFID) system that tracks the instruments during the procedure. With this information, the different phases of the procedure can be recognized and this will aid in the communication and the prediction of the surgical end-time. To be able to detect the instruments with an RFID system, a minimal reading distance is required. In this study, different approaches are tested to increase the maximal reading distance of RFID ’on-metal’ tags to ensure the range is far enough for the technique to be used during a totally extraperitoneal (TEP) procedure in the OR. The desired reading distance is 50 cm. The study started with a set of instruments with RFID tags attached to them. In a pilot study, the reading distances were measured and resulted in an average reading distance from the antenna which was too low. Using a larger antenna resulted in a slightly higher average reading distance, but still not high enough. Raising the power of the antenna could be increasing the reading distance. The tests are, however, already performed with the maximally allowed 2 W. To determine the problem with the reading distance, the different properties of the attachment of the RFID tag to the instruments are investigated. The influences of the different properties are tested and the results are combined to make a final design that is supposed to have a higher maximal reading distance than the instruments in the pilot study. The final design is tested both in the clinical lab at the TU Delft and in an operating room at the Reinier de Graaf hospital in Voorburg. The reading distances of the tags on the final design were improved and sufficient for the use in a TEP procedure. Finally, the tags are attached to three instruments with a temporary connection to measure the reading distances with the influences of the instruments. The results of this test show that the desired reading distances can be accomplished with RFID technology.

Hospitals are under an increased financial pressure, due to a significant growth in demand for healthcare, that is caused by an aging population. The operating rooms account for the largest costs of a hospital, and thus require a cost-efficient management. However, scheduling the operating rooms is a complex task that involves the estimation of surgery duration, which is often inaccurate. Delays in surgery duration, that are not accounted for in the estimation during scheduling, often result in upcoming surgeries being cancelled. Hence, the operating theatres are most of the time not fully utilized, which comes with great costs for the hospital. Poor communication of information about the progress of ongoing surgeries to the operating room (OR) schedulers prevents them from effectively (re)-scheduling accordingly. The OR personnel can not be assigned to additional tasks, and thus, there is a need for automated monitoring of the progress of ongoing surgeries. The instrument usage during surgeries is shown to provide relevant information about the progress of surgeries, using a Random Forest model to estimate surgical phases from intra-operative data.In this thesis, a Radiofrequency Identification (RFID) setup is used to detect instruments, equipped with RFID-tags, that are used by the surgeon during a Total Extraperitoneal Laparoscopic Hernia Repair (TEP) procedure at Reinier de Graaf Gasthuis (RdGG). The setup is evaluated on applicability into a surgical setting, which involves regulatory aspects, acceptance by the OR-personnel, and performance. A pilot study, of which the results are incorporated into realizing actual in-vivo tests, is performed in a near-surgical setting to eval- uate the extent to which the RFID-setup is applicable in a real surgical setting. During the pilot study, a total of 10 procedures is mimicked of which the data, that is extracted from the RFID-setup, is used to generate a Random Forest model that can estimate the surgical phases. The Random Forest model is used to evaluate the performance of the RFID-setup. After complying with all regulations to perform in-vivo testing, a total of three in-vivo tests is executed to evaluate the applicability of the RFID-setup in a real surgical setting. Lastly, a first step has been taken to extend the research to a greater range of surgery types.The RFID-setup has shown the ability to identify instruments, that are equipped with RFID-tags, during surgery. All regulations to perform in-vivo tests are complied with, and no discomfort of the RFID-setup is experienced by the OR-personnel during the in-vivo tests. Hence, future in-vivo testing is warranted to optimize the setup. The Random Forest model can estimate the phases of surgeries (38% overall accuracy), based on instrument usage data that is acquired through an RFID-setup. The current setup, however, needs to be optimized to improve the detection ability. So far, the first step to make the method of instrument identification applicable to a broader range of surgeries has resulted in a prototyped attachment design to equip instruments with RFID-tags. The attachment is designed in such a way that both the attachment and the RFID-tags are interchangeable between instruments. Further development is needed for the design to comply with a selection of regulations to perform in-vivo testing.

In the Netherlands, approximately 1.750 people are diagnosed with pancreatic cancer each year. Approximately 20% of these new patients are operated with curative intent. This surgical treatment, called pancreaticoduodenectomy leads to a five-year survival rate of 5-10%. Laparoscopic pancreaticoduodenectomy (LPD) is a complex surgical procedure that pancreas surgeons have only started to adopt. In the Netherlands, the four pioneering hospitals in laparoscopic pancreatic surgery (Catharina Ziekenhuis (CTZ), Jeroen Bosch Ziekenhuis (JBZ), Amsterdam Medisch Centrum (AMC) and Onze Lieve Vrouwe Gasthuis (OLVG)) are still in the beginning of their learning curve. An early assessment of their operative technique could provide deep insight in the differences of the operative method between the hospitals. This is an experimental study to evaluate the LPD procedure with the aim to improve the operative techniques of the four pioneering hospitals in the Netherlands. In each of the four hospitals, the steps of the LPD procedure were defined based on the operation report. For each step of the procedure the risks and risk scores were identified. This was done with a multidisciplinary team per hospital according to the hazard analysis of the Health Failure Mode and Effect Analysis (HFMEA). In consultation with one surgeon of each of the four hospitals, the risks were converged to relevant risks s according to the adapted decision tree of the HFMEA method. The similar steps of the four hospitals were linked to each other to create an overview of the differences and similarities in process and risks. Finally, risk types and the corresponding causes were identified based on the relevant risks. In all included hospitals, relevant risks were found (CTZ: n = 10, JBZ: n = 16, AMC: n = 3 and OLVG: n = 13). The process steps which contained relevant risks by more than one surgical teams were (1) performing Kocher maneuver and exposing ligament of Treitz, (2) cholecystectomy, (3) mobilising portal vein, superior mesenteric vein and artery, (4) transection gastroduodenal artery, (5) pancreatojejunostomy (PJ), (6) hepaticojejunostomy (HJ) and (7) gastrojejunostomy (GJ). Eight out of 41 relevant risks were accepted by the surgeon of the corresponding hospital (no further action is warranted to diminish the risk). The remaining relevant risks were bleeding (n = 23), HJ failure (n = 4), PJ failure (n = 3) and GJ failure (n = 3). The prevalent reason for bleeding was unable to view or identify anatomical structures of the patient (33%). HJ and PJ failure originated from patient’s habitus and iatrogenic/operative technique. GJ failure originated from iatrogenic/operative technique solely. The HFMEA method provided an overview of the practiced operative methods during the LPD procedure for each of the included hospitals with detailed information of the surgical steps. There are clear differences in the order of several surgical steps between the four hospitals. This information could be used by the surgeons to learn from each other by sharing their considerations and knowledge about specific process steps.