The surgical symphony of human efficiency: a structured intraoperative workflow model for high-volume cochlear implant missions

Objective High-volume humanitarian Cochlear Implant (CI) missions require highly organized workflows to maintain efficiency and safety. This study describes the intraoperative model used during a large-scale CI campaign. Methods A descriptive observational design was used to evaluate operative workflow across multiple operating rooms using standardized surgical protocols, structured shift-based assignments, and digital coordination. Operative times, intraoperative findings, ECAP responses, and postoperative radiologic outcomes were analyzed. Results A total of 142 CI surgeries were completed over three days (30-, 66-, and 46-cases). The mean operative time was 57-minutes, with a median of 46-minutes. Unremarkable intraoperative fields were observed in 57.4% of cases, while perilymph oozing occurred in 31.2%. Absent ECAP responses occurred in three patients (2.1%) with inner ear malformations; all demonstrated responses during postoperative fitting. Radiologic assessment confirmed proper intracochlear insertion in all candidates. Conclusion A structured intraoperative workflow enabled the safe and efficient completion of a high surgical volume within a short timeframe. This experience offers practical guidance for centers aiming to enhance operating room efficiency, particularly in high-volume or resource-limited environments. Level of Evidence IV.