• Matthias Weigl, Jeannette Weber, Elyse Hallett, Michael Pfandler, Boris Schlenker, Armin Becker, and Ken Catchpole.
• Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-University Munich, Munich, Germany. Electronic address: matthias.weigl@med.lmu.de.
• Urology. 2018 Apr 1; 114: 105-113.

ObjectiveTo identify type and severity of surgical flow disruptions and to determine their impact on the perception of intraoperative teamwork.MethodsForty radical prostatectomy cases were studied in an academic department for urology. A standardized observational tool for identification of type and severity of flow disruptions was applied during real-time prostatectomy procedures. Additionally, all operating room team members evaluated intraoperative teamwork immediately after the procedure. Procedures were divided into 4 phases: prerobot, docking, console time, and postrobot.ResultsA total of 2012 flow disruptions were observed, with an average rate of 16.27 events per hour. The highest rate was during the robot docking phase. Although the frequency of disruption types varied across phases, the most severe disruptions were related to communication and coordination during the prerobot and docking phase. Equipment- and communication-related disruptions were mostly severe during the time the surgeons were on the console. Among the surgeons, we identified a significant relationship between disruptions and intraoperative teamwork such that during procedures with frequent severe disruptions, surgeons experienced inferior teamwork (β = -0.40, P = .01). This was not the case for nurses and anesthetists.ConclusionEmphasis on improving operating room team communication and coordination would help to establish efficient and smooth surgical workflow.Copyright © 2018 Elsevier Inc. All rights reserved.

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