Surgical experience and identification of errors in laparoscopic cholecystectomy.

Autor:	Humm GL; Wellcome/Engineering and Physical Sciences Research Council Centre for Interventional and Surgical Sciences, University College London, London, UK.; UCL Division of Surgery and Interventional Science, University College London, London, UK., Peckham-Cooper A; Leeds Institute of Emergency General Surgery, Leeds Teaching Hospital NHS Trust, Leeds, UK., Chang J; Department of General Surgery, Shrewsbury and Telford Hospital NHS Trust, Royal Shrewsbury Hospital, Shrewsbury, UK., Fernandes R; Department of General Surgery, East Kent Hospitals University Foundation Trust, William Harvey Hospital, Ashford, UK., Gomez NF; UCL Division of Surgery and Interventional Science, University College London, London, UK., Mohan H; Department of Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.; Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia., Nally D; Department of General Surgery, Mater Misericordiae University Hospital, Dublin, Ireland., Thaventhiran AJ; Department of General Surgery, Royal London Hospital, Barts Health NHS, London, UK., Zakeri R; UCL Division of Surgery and Interventional Science, University College London, London, UK., Gupte A; Department of General Surgery, University College London Hospital NHS Foundation Trust, University College Hospital, London, UK., Crosbie J; UCL Division of Surgery and Interventional Science, University College London, London, UK., Wood C; UCL Division of Surgery and Interventional Science, University College London, London, UK., Dawas K; UCL Division of Surgery and Interventional Science, University College London, London, UK., Stoyanov D; Wellcome/Engineering and Physical Sciences Research Council Centre for Interventional and Surgical Sciences, University College London, London, UK., Lovat LB; Wellcome/Engineering and Physical Sciences Research Council Centre for Interventional and Surgical Sciences, University College London, London, UK.; UCL Division of Surgery and Interventional Science, University College London, London, UK.
Jazyk:	angličtina
Zdroj:	The British journal of surgery [Br J Surg] 2023 Oct 10; Vol. 110 (11), pp. 1535-1542.
DOI:	10.1093/bjs/znad256
Abstrakt:	Background: Surgical errors are acts or omissions resulting in negative consequences and/or increased operating time. This study describes surgeon-reported errors in laparoscopic cholecystectomy. Methods: Intraoperative videos were uploaded and annotated on Touch SurgeryTM Enterprise. Participants evaluated videos for severity using a 10-point intraoperative cholecystitis grading score, and errors using Observational Clinical Human Reliability Assessment, which includes skill, consequence, and mechanism classifications. Results: Nine videos were assessed by 8 participants (3 junior (specialist trainee (ST) 3-5), 2 senior trainees (ST6-8), and 3 consultants). Participants identified 550 errors. Positive relationships were seen between total operating time and error count (r2 = 0.284, P < 0.001), intraoperative grade score and error count (r2 = 0.578, P = 0.001), and intraoperative grade score and total operating time (r2 = 0.157, P < 0.001). Error counts differed significantly across intraoperative phases (H(6) = 47.06, P < 0.001), most frequently at dissection of the hepatocystic triangle (total 282; median 33.5 (i.q.r. 23.5-47.8, range 15-63)), ligation/division of cystic structures (total 124; median 13.5 (i.q.r. 12-19.3, range 10-26)), and gallbladder dissection (total 117; median 14.5 (i.q.r. 10.3-18.8, range 6-26)). There were no significant differences in error counts between juniors, seniors, and consultants (H(2) = 0.03, P = 0.987). Errors were classified differently. For dissection of the hepatocystic triangle, thermal injuries (50 in total) were frequently classified as executional, consequential errors; trainees classified thermal injuries as step done with excessive force, speed, depth, distance, time or rotation (29 out of 50), whereas consultants classified them as incorrect orientation (6 out of 50). For ligation/division of cystic structures, inappropriate clipping (60 errors in total), procedural errors were reported by junior trainees (6 out of 60), but not consultants. For gallbladder dissection, inappropriate dissection (20 errors in total) was reported in incorrect planes by consultants and seniors (6 out of 20), but not by juniors. Poor economy of movement (11 errors in total) was reported more by consultants (8 out of 11) than trainees (3 out of 11). Conclusion: This study suggests that surgical experience influences error interpretation, but the benefits for surgical training are currently unclear. (© The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu