Video-assisted surgery : suggestions for failure prevention in laparoscopic cholecystectomy

Abstract

Background: Surgery differs from other medical specialties in its execution. It is often complex and includes considerable individual variations. Observing problems in operating theatres (OT) allows for the identification of system failures which should be defined for learning purposes to increase patient safety and enhance general safety culture within hospital organizations. This study evaluates a common video-assisted surgical procedure, laparoscopic cholecystectomy (LC) through failure analysis. The profile of the LC procedure and failure sources is presented. Methods: Data consisted video-observations and interviews concerning twelve LC operations performed at a day surgery unit. All operations were teaching sessions. Qualitative analysis was undertaken. Through task analysis, specialist interviews and failure identification a failure profile of LC was produced. Results: Twenty failure types were identified, failures were for example: remote attention towards ergonomics; novice’s skill failures; inadequate supervision and unnecessary risk taking caused by tight operating schedules. The results showed that the importance of working principles should be emphasized. The failure profile of LC revealed three phases featuring multiple failures: dissecting the peritoneal covering; identifying, sealing and cutting the cystic duct and cystic artery; detaching the gallbladder from the hepatic bed and inspecting the hepatic bed. Conclusions: This study offers information for hospital organizations about the current state of surgical work and surgical skills learning. This information could be exploited in the development of system defences: error prevention mechanisms through investing in the redesign of work tasks and working methods; as well as reinforcing education and training for enhancing patient safety in OT.