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The purpose of this paper is to generate a daily operating theater schedule aiming to minimize completion time and maximum overtime while integrating real-life surgeon constraints, such as their role, specialty, qualification and availability.

The paper deals with complete surgery process using multi-objective surgery scheduling approach. Furthermore, the combinatorial nature of the studied problem does not allow to solve it to optimality. Therefore, the authors developed two approaches embedded in a tabu search metaheuristic, namely, weighted sum and e-constraint, to minimize completion time and maximum overtime.

The integration of the upstream and downstream services of an intervention and the consideration of the specific constraints related to surgeons are very essential to obtaining more closed schedules to the realty.

The paper includes implications for the development of efficient schedules for a significant number of operations coming from different specialties throughout its complete surgery process under multi-resource constraints.

The paper can help hospital managers and decision makers to well manage the budget by minimizing the overtime cost and by offering efficient daily operating theater schedule.

The results of the paper will help hospital managers and decision makers to well manage the budget by minimizing the overtime cost and offering efficient daily operating theater schedule.

Operating theaters are considered as the most sensitive health department within hospital centers due to their significant cost/necessity for patients and their economic benefits for hospitals. In this paper, the authors consider patients that may require more than one surgery on the same day in the surgery scheduling problem which is a major technology enhancement in the health industry.

The surgery scheduling includes both the preoperative and the postoperative units of the operative stage. Two objectives are considered in a lexicographic way: the minimization of the makespan while prioritizing the patients having two surgeries and the total completion time to perform. An adapted tabu-search algorithm is used to tackles this NP-hard scheduling problem.

The proposed schedule is more relevant for operating theaters as it integrates all stages of the surgical procedure and considers patients with more than one operation during the same day.

This paper is original as it considers patients who need more than one operation, which responds to real challenge faced by decision-makers' in hospitals. The application of the time lags between stages of the surgical procedure generates a good utilization of the hospital resources and makes the scheduling task more flexible.

Aims to assess the surgeons' communication skills with patients in the orthopaedic department of the authors' district general hospital.

A departmental prospective audit was conducted involving all consultants and middle grade surgeons. Then authors used a validated questionnaire (Doctors' Interpersonal Skills Questionnaire (DISQ)) completed by patients and analysed independently. Feedback was obtained through individual confidential reports and a study group meeting.

A total of 402 patient evaluations were received and the average interpersonal skills index was 72 per cent ranging between 55 per cent and 87 per cent. The highest scores were given for respect shown, warmth of greeting and patients' confidence in the surgeon's abilities. The lowest scores were given for time given to patients to express their concerns.

The research has an incomplete audit circle. A second audit is required following appropriate training to alleviate the deficiencies reported in the first audit and prove the benefit.

This audit highlighted important deficiencies in our interpersonal skills that could potentially be addressed by way of targeted training. This kind of assessment should become an essential part of the annual appraisal process of all hospital doctors.

This paper is the first to report the results of a departmental assessment process of hospital doctors using the DISQ.

The purpose of this paper is to present simulation modelling to reconfigure a 700-bed Hong Kong hospital’s master surgery schedule (MSS), aiming to improve patient flow, capacity management and resource allocation through levelling bed occupancy within the hospital.

A discrete-event simulation model was developed to understand how changes to the MSS would affect bed occupancy, thereby providing business intelligence for short- and long-term hospital planning. A decision tool was subsequently developed for hospital managers to test different scenarios.

Simulation modelling showed that significant bed occupancy levelling could be achieved through small and practicable changes to the MSS. Optimisation routines conducted using the simulation model then gave additional insights into how the schedule should be revamped for the long term.

The authors show how operations research methods are useful for guiding hospital operational planning. The authors show that a data-driven and evidence-based model enables hospital managers to critically explore various scheduling changes, while also providing a scientific common ground for discussion among important stakeholders. It is a crucial step forward when adopting advanced analytics for Hong Kong hospital operational planning.

The authors provide a robust method for evaluating the relationship between Hong Kong hospital’s MSS and its bed occupancy. Through simulating various changes to the surgical schedule, valuable and practicable insights were made available for hospital managers to make short- and longer-term changes that enhance the system’s overall efficiency and service quality.

The purpose of this paper is to study how budgetary constraints can have ethical implications on patient treatment options.

By applying a qualitative methodological approach (interviews) and participant observation, this paper studies the behaviour of surgeons in scenarios of financial restriction.

The empirical findings show that despite the conflict between the economy and the leges artis, surgeons maintain the ethical and deontological principles of their profession with fair rules of orientation.

The importance of this study can be realised by its continuity. One of the authors is already implicated on a wider research to investigate the influence of the economic scarcity of resources on general surgeons’ ethical behaviours.

This paper is a contribution to understanding the rules that restrain the activities of surgeons. Politicians sometimes do not have a full understanding of the pressures that the medical profession faces in their day-to-day activities. Currently, with the addition of problems relate to COVID-19, politicians and populations seem to better understand the importance of the Serviço Nacional de Saúde (SNS), This paper hopes that this understanding will be not only a conjectural moment.

In conjunction with the economic recession that began in the first decade of this century, health institutions have long faced budgetary constraints that condition their material and human resources and correspondingly shape the scope of health professional activities. Until now, it has not been studied the impact of economic crises on the ethical behaviour of Portuguese surgeons. Therefore, this research is a first step and a useful contribution to understanding the rules that can restrain (or not) the ethical conduct of these health professionals.

This paper aims to fill a research gap by presenting design and 3D printing guidelines and considerations which apply to the development process of patient-specific osteotomy guides for orthopaedic surgery.

Analysis of specific constraints related to patient-specific surgical guides design and 3D printing, lessons learned during the development process of osteotomy guides for orthopaedic surgery, literature review of recent studies in the field and data gathered from questioning a group of surgeons for capturing their preferences in terms of surgical guides design corresponding to precise functionality (materializing cutting trajectories, ensuring unique positioning and stable fixation during surgery), were all used to extract design recommendations.

General design rules for patient-specific osteotomy guides were inferred from examining each step of the design process applied in several case studies in relation to how these guides should be designed to fulfill medical and manufacturing (fused deposition modelling process) constraints. Literature was also investigated for finding other information than the simple reference that the surgical guide is modelled as negative of the bone. It was noticed that literature is focussed more on presenting and discussing medical issues and on assessing surgical outcomes, but hardly at all on guides’ design and design for additive manufacturing aspects. Moreover, surgeons’ opinion was investigated to collect data on different design aspects, as well as interest and willingness to use such 3D-printed surgical guides in training and surgery.

The study contains useful rules and recommendations for engineers involved in designing and 3D printing patient-specific osteotomy guides.

A synergetic approach to identify general rules and recommendations for the patient-specific surgical guides design is presented. Specific constraints are identified and analysed using three case studies of wrist, femur and foot osteotomies. Recent literature is reviewed and surgeons’ opinion is investigated.

Minimally invasive surgery (MIS) is a cost‐effective alternative to the open surgery whereby essentially the same operations are performed using specialized instruments designed to fit into the body through several tiny punctures instead of one large incision. The EndoBots (Endoscopic Robots) described here are designed for collaborative operation between the surgeon and the robotic device. The surgeon can program the device to be operated completely manually, collaboratively where motion of the robotic device in certain directions is under computer control and in others under manual surgeon control, or autonomously where the complete device is under computer control. Furthermore, the robotic tools can be quickly changed from a robotic docking station, allowing different robotic tools to be used in an operation.

A “hands‐on” robotic system for total knee replacement (TKR) surgery is presented. Computed tomography (CT) based software is used to accurately plan the procedure pre‐operatively. Intra‐operatively, the surgeon guides a small, special‐purpose robot, called Acrobot^®, which is mounted on a gross positioning device. The Acrobot uses active constraint control, which constrains the motion to a pre‐defined region, and thus allows the surgeon to safely cut the knee bones to fit a TKR prosthesis with high precision. A non‐invasive anatomical registration method is used. The system has undergone early clinical trials with very promising outcomes.

Cataract surgery is a highly successful, high‐volume surgery, hence reducing surgical complications are imperative for organizations to deliver cost‐effective, high‐quality services that meet the needs of patients. This paper aims to describe 18‐month results of a sustainable program to maximize the safety of cataract surgery training.

Modifications to the comprehensive cataract‐training program and tested were developed in a controlled, interventional case series to evaluate their effect on trainee complication rates. Data collection and interpretation were performed in a prospective and blind manner.

Prior to intervention, PCR rates for trainee‐surgeons averaged 3.34 per cent cf international published figures of 4.6‐10 per cent. This compared with 1.89 per cent PCR rate for trained cataract surgeons (p<0.002, Mann Whitney test). Multiple interventions were introduced and enforced to maximize cataract surgery training safety. After 18 months follow‐up data were consistent with a statistically significant reduction in trainee PCR rates (1.53 per cent, p<0.007, Wilcoxon Signed Ranks test) compared with trained cataract surgeons (1.23 per cent, p<0.074, Wilcoxon Signed Ranks test). Parameters of training efficacy were improved or maintained during this period.

Limitations included using trained cataract surgeons as controls as apposed to a similar group of trainee surgeons. In addition, multiple interventions were simultaneously instituted, making identification of a single influential factor impossible to identify.

Maximally safe and effective cataract surgery training is achieved in Singapore without compromising service and quality markers. Similar training goals can be extrapolated to other surgical disciplines.

This is the first study to demonstrate maximally safe and effective cataract surgery training in a large patient group, over sustained periods.