Critical factors influencing intra-operative surgical decision-making

The development of intra-operative surgical decision support systems requires a thorough understanding of the factors influencing the decision-making of surgeons in the surgical workspace. These factors are a construct of the surgical workspace which generate situation awareness and hence provide real-time information to guide intra-operative decision-making The knowledge of these factors is especially required to provide real-time image guidance or procedural support to the surgeons´ via surgical information systems to assist the minimally invasive techniques. Related research has focused on investigating the types of decision-making strategies that surgeons may use such as intuitive (recognition-primed), rule based, option comparison and creative. The researches have not investigated the factors influencing the intra-operative surgical decision-making. Addressing this gap the presented research focuses on the following two questions: First: which critical factors influence the intra-operative surgical decision-making, and second: are there differences in importance of these factors for different minimally invasive techniques? In order to answer these questions two studies have been conducted with surgeons related to three different minimally invasive techniques. The first study included three focus group sessions with 20 surgeons. The second study confirms the findings of the first study by conducting real-time observations (n=15) in the surgical workspace. The findings reveal that three factors are of major importance: task visualization, communication and mental model. These factors are elaborated by illustrating their influence on decision-making during the minimally invasive techniques. On the basis of these result basic guidelines for the development of expert decision-support system have been derived.