Minimally invasive surgery training using multiple port-sites to improve performance

White, Alan; Giles, Oscar; Sutherland, R. J.; Ziff, Oliver J.; Mon-Williams, Mark; Wilkie, Richard M.; Lodge, J.P.A.

doi:10.1016/j.ijsu.2013.06.052

“…Use of these instruments also means that the surgeon must adapt to the fulcrum effect (where the hand needs to move in the opposite direction to that in which the tip of the instrument needs to move). 5,6 These constraints and novel visuomotor demands increase the risk of inadvertent injury to the patient. In response to this, a number of studies have examined the factors affecting MIS performance.…”

mentioning

confidence: 99%

Inconsistent reporting of minimally invasive surgery errors

White

¹

,

Skelton

²

,

Mushtaq

³

et al. 2015

annals

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INTRODUCTION Minimally invasive surgery (MIS) is a complex task requiring dexterity and high level cognitive function. Unlike surgical 'never events', potentially important (and frequent) manual or cognitive slips ('technical errors') are underresearched. Little is known about the occurrence of routine errors in MIS, their relationship to patient outcome, and whether they are reported accurately and/or consistently. METHODS An electronic survey was sent to all members of the Association of Surgeons of Great Britain and Ireland, gathering demographic information, experience and reporting of MIS errors, and a rating of factors affecting error prevalence. RESULTS Of 249 responses, 203 completed more than 80% of the questions regarding the surgery they had performed in the preceding 12 months. Of these, 47% reported a significant error in their own performance and 75% were aware of a colleague experiencing error. Technical skill, knowledge, situational awareness and decision making were all identified as particularly important for avoiding errors in MIS. Reporting of errors was variable: 15% did not necessarily report an intraoperative error to a patient while 50% did not consistently report at an institutional level. Critically, 12% of surgeons were unaware of the procedure for reporting a technical error and 59% felt guidance is needed. Overall, 40% believed a confidential reporting system would increase their likelihood of reporting an error. CONCLUSION These data indicate inconsistent reporting of operative errors, and highlight the need to better understand how and why technical errors occur in MIS. A confidential 'no blame' reporting system might help improve patient outcomes and avoid a closed culture that can undermine public confidence. KEYWORDSMinimally invasive surgery -Laparoscopy -Medical errors -Decision making Humans spend much of their day engaged in skilled behaviours (such as driving a car or writing with a pen) that involve complex motor and cognitive processes. The ease with which these skills are normally accomplished is a testament to the incredible capacity of the human nervous system (and years of training). Nevertheless, everyone has experienced an 'off-task moment' where movements are clumsy and/or online decisions are not as fast or accurate as required. The impact of this depends on the behaviour being executed: errors when writing usually have minimal cost whereas errors when driving can have catastrophic consequences.While a great deal of research has concentrated on surgical 'never events' (serious yet preventable errors), the safety mechanisms in a surgical setting mean that most technical errors do not result in a cataclysmic outcome (ie patient death). Despite this, the errors that do occur can still have a high cost to the patient and the health service; technical errors in a healthcare setting can lead to delayed or prolonged medical care, and patients may suffer unnecessary pain and/or be rendered disabled.1 Furthermore, the probability of a cataclysmic outcome must logi...

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“…Our measures capture critical visuomotor transformations (tracking, steering, and aiming) that underlie many activities of daily living and reflect core factors of real-world skills such as handwriting, postural control and driving. More specifically, the CKAT software used in the present study [46] has been previously been used to investigate fine-motor control across a range of ages including children and older adults [47,56], in healthy and clinical populations [57][58][59], and has been used to investigate the cognitive underpinnings of skill acquisition [60], as well as the development of specific motor skills such as handwriting and laparoscopic surgery [61,62]. In terms of investigating the impact of degraded monocular vision and motor function, Domkin and colleagues demonstrated that changes to VA predicted changes in performance on a low contrast version of the CKAT aiming task [36].…”

Section: Methodsmentioning

confidence: 99%

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“…Our measures capture critical visuomotor transformations (tracking, steering, and aiming) that underlie many activities of daily living and reflect core factors of real-world skills such as handwriting, postural control and driving. More specifically, the CKAT software used in the present study [46] has been previously been used to investigate fine-motor control across a range of ages including children and older adults [47,56], in healthy and clinical populations [57][58][59], and has been used to investigate the cognitive underpinnings of skill acquisition [60], as well as the development of specific motor skills such as handwriting and laparoscopic surgery [61,62]. In terms of investigating the impact of degraded monocular vision and motor function, Domkin and colleagues demonstrated that changes to VA predicted changes in performance on a low contrast version of the CKAT aiming task [36].…”

Section: Methodsmentioning

confidence: 99%

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Minimally invasive surgery training using multiple port-sites to improve performance

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Inconsistent reporting of minimally invasive surgery errors

Inconsistent reporting of minimally invasive surgery errors

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