Application of rules 1 to 6 for maximizing government infrastructure utilization in laparoscopic cholecystectomy: A case series analysis

Laparoscopic cholecystectomy (LC) is the gold standard treatment for gallstone disease, but long waiting lists are common in India due to high disease prevalence and limited government resources. Therefore, it is of interest to evaluate a two-operation room (OR) model to optimise resource utilisation, in which patient preparation in one OR was overlapped with surgical steps in another OR. A total of 64 patients were operated on over three days, with an average operative time of 24.45 minutes per case; significantly more surgeries were completed in 6 hours with the new model (21.3 cases) compared to routine practice (6.3 cases in 8 hours, p <0.05). Most patients were female (98%), with a mean age of 44.8 years and operative times ranged from 9 to 55 minutes. The "1-6 rule" (1 consultant, 2 ORs, 3 assistants, 4 anaesthetists, 5 nursing/support staff and 6 hours of surgery) may be an innovative policy strategy for maximising LC efficiency in government hospitals.