Reviewer ’s report  
 
Title: Gynaecologists' and General Surgeons' preference for the features of integrated theatres: a 
discrete choice experiment.  
 
Version: 0 Date: 17 May 2 017 
 
Reviewer: Armin Schneider  
 
Reviewer's report:  
 
Dear authors,  
 
You did a discrete choice experiment with a questionnaire sent to general surgeons and 
Gynecologists to assess preferences of functionalities in integrated theaters and to compare these 
between general surgeons and Gynecologists.   
To my knowledge, up to n ow there´s a lack in studies, showing which functionalities are 
preferred in integrated theaters. You did a discrete choice experiment to answer this question. 
However, there are a lot of improvements necessary to make the paper suitable for publication:  
 
1. Cited literature is very antiquarian and not well chosen (Line 121: "Integrated theatres 
potentially result in reduced stress for the operating team and enhanced efficiency during the 
operation (10)". Reference 10 is 20years old, this is the time were f irst integrated theaters 
were installed. In addition, the cited reference compares not directly the efficiency, 
furthermore the posture of the surgeon. Please do another literature research with more actual 
and better fitting references.   
 
2. It does not become clear how many surgeons you invited to participate in the study  
 
3. The attached Excel sheet is unusable, because cell formatting got lost. I got a date format in 
the column: "How many hours on average do you spend performing laparosco pic surgery 
each week?"  
 
4. Unfortunately the questions were not chosen in a way to get useful results or topics which do 
not address the surgeon.  Have You ever changed the CO2 canister? Typically this is done by 
the unsterile nurse, maybe you should ask her about her preferences. Same lasts for 
positioning of the trolleys. The questions are ideal to do the survey with supportive personell.  
 
5. You are completely right, today wireless video transmission is possible. However, 
technically this is much more th an bluetooth, to my knowledge it is a combination of 
bluetooth and WiFi. The data rate of bluetooth only is far too low. Please correct this and 
describe the technology also with limitation (line of sight!)  
 
6. In background you mention down time for the in stallation process from 2 - 12 weeks. Can 
you prove this? Three month seems to me a complete misplanning, where I would start a 
recourse claim.  
If you address the installation breakdown, you also have to consider the improved efficiency in 
integrated thea tres (i.e.: van Det MJ, Meijerink WJ, Hoff C, Pierie JP. Interoperative efficiency 
in minimally invasive surgery suites. Surg Endosc. 2009 Oct;23(10):2332 -7) 
7. Wire free floors with floor mounted screens sounds good, the reality will be different: You 
still will need a power cable, mostly the plug socket is too far away, which means an 
additional extension cable  
 
8. You also considered surgeons answering the question "Have you ever operated in an 
integrated theatre" - at an industry product demonstration. T hese group of surgeons is not 
representative, working one day in an absolutely ideal installed theatre is not the reality. 
Compare only surgeons having experience in integrated theaters as well as in "standard" 
OR´s  
Please revise the paper carefully, and involve a statistician for graphical results.  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the  necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
  
Are you able to assess  any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
Not relevant to this manu script  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares  in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you recei ved reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
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