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Application of failure mode and effect analysis in laparoscopic colon surgery training.

Alba Mesa F, Sanchez Hurtado MA, Sanchez Margallo FM, Gomez Cabeza de Vaca V, Komorowski AL - World J Surg (2015)

Bottom Line: Risk priority number (RPN) has been calculated for every surgery, and the results have been discussed at the end of each training day with all participants.Only two teams out of 24 were not able to reach a RPN of less than 300 during third OR session.When the type of failures were analysed, we have observed a shift from procedure-type failures to technical failures that depended on each participant technical abilities.

View Article: PubMed Central - PubMed

Affiliation: Consorcio Sanitario Publico del Aljarafe, Hospital San Juan de Dios, Bormujos, Sevilla, Spain.

ABSTRACT

Aim: To evaluate if application of failure mode and effect analysis (FMEA) to laparoscopy training can help surgeons acquire laparoscopy skills.

Methods: After preparing a FMEA matrix of laparoscopic sigmoidectomy, we have introduced it during three laparoscopy courses. Forty-eight surgeons, divided into 24 teams of two surgeons, have participated in three courses. During each course, every team has performed three laparoscopic sigmoidectomies in three experimental animals (1 OR session every day). Risk priority number (RPN) has been calculated for every surgery, and the results have been discussed at the end of each training day with all participants.

Results: We have observed a decline in the median RPN from 1339 during the first OR session through 62 during second OR session to reach 0 in the third OR session. Only two teams out of 24 were not able to reach a RPN of less than 300 during third OR session. When the type of failures were analysed, we have observed a shift from procedure-type failures to technical failures that depended on each participant technical abilities.

Conclusion: Application of FMEA principles to laparoscopy training can help acquire non-technical skills necessary for safe laparoscopic surgery.

Show MeSH
RPN results for each group for three consecutive operations for each OR session: a OR session 1, b OR session 2, c OR session 3. RPN—risk priority number
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Related In: Results  -  Collection


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Fig1: RPN results for each group for three consecutive operations for each OR session: a OR session 1, b OR session 2, c OR session 3. RPN—risk priority number

Mentions: As we can see in Fig. 1, only three surgical teams out of 24 were able to obtain a RPN of less than 1000 points during the first session in the OR. However, the RPN result of each team had a tendency to decrease during the training course from a median RPN of 1339 ± 457 (first experimental animal) through 62 ± 381 (second experimental animal) to finally reach a median of 0 ± 130 (third experimental animal). Already during second OR session, only 5 teams received a RPN of more than 300 points. Interestingly, between the first and the second OR sessions, the students did not receive any technical training. As stated in the Methods section, during the discussion after the first OR session, we have only pointed out at which phases of the process the teams committed mistakes and how much those mistakes costed them in terms of RPN score. Also, the meaning of the final RPN result was clearly defined as acceptable or non-acceptable level of the risk for the patient. So, the decline in the RPN result during the second session was as the matter of fact only a result of the discussion about the failure mode and its implications for the patient. This effect was even stronger during the third OR session when only two teams were not able to receive a RPN score of less than 300 points.Fig. 1


Application of failure mode and effect analysis in laparoscopic colon surgery training.

Alba Mesa F, Sanchez Hurtado MA, Sanchez Margallo FM, Gomez Cabeza de Vaca V, Komorowski AL - World J Surg (2015)

RPN results for each group for three consecutive operations for each OR session: a OR session 1, b OR session 2, c OR session 3. RPN—risk priority number
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4300411&req=5

Fig1: RPN results for each group for three consecutive operations for each OR session: a OR session 1, b OR session 2, c OR session 3. RPN—risk priority number
Mentions: As we can see in Fig. 1, only three surgical teams out of 24 were able to obtain a RPN of less than 1000 points during the first session in the OR. However, the RPN result of each team had a tendency to decrease during the training course from a median RPN of 1339 ± 457 (first experimental animal) through 62 ± 381 (second experimental animal) to finally reach a median of 0 ± 130 (third experimental animal). Already during second OR session, only 5 teams received a RPN of more than 300 points. Interestingly, between the first and the second OR sessions, the students did not receive any technical training. As stated in the Methods section, during the discussion after the first OR session, we have only pointed out at which phases of the process the teams committed mistakes and how much those mistakes costed them in terms of RPN score. Also, the meaning of the final RPN result was clearly defined as acceptable or non-acceptable level of the risk for the patient. So, the decline in the RPN result during the second session was as the matter of fact only a result of the discussion about the failure mode and its implications for the patient. This effect was even stronger during the third OR session when only two teams were not able to receive a RPN score of less than 300 points.Fig. 1

Bottom Line: Risk priority number (RPN) has been calculated for every surgery, and the results have been discussed at the end of each training day with all participants.Only two teams out of 24 were not able to reach a RPN of less than 300 during third OR session.When the type of failures were analysed, we have observed a shift from procedure-type failures to technical failures that depended on each participant technical abilities.

View Article: PubMed Central - PubMed

Affiliation: Consorcio Sanitario Publico del Aljarafe, Hospital San Juan de Dios, Bormujos, Sevilla, Spain.

ABSTRACT

Aim: To evaluate if application of failure mode and effect analysis (FMEA) to laparoscopy training can help surgeons acquire laparoscopy skills.

Methods: After preparing a FMEA matrix of laparoscopic sigmoidectomy, we have introduced it during three laparoscopy courses. Forty-eight surgeons, divided into 24 teams of two surgeons, have participated in three courses. During each course, every team has performed three laparoscopic sigmoidectomies in three experimental animals (1 OR session every day). Risk priority number (RPN) has been calculated for every surgery, and the results have been discussed at the end of each training day with all participants.

Results: We have observed a decline in the median RPN from 1339 during the first OR session through 62 during second OR session to reach 0 in the third OR session. Only two teams out of 24 were not able to reach a RPN of less than 300 during third OR session. When the type of failures were analysed, we have observed a shift from procedure-type failures to technical failures that depended on each participant technical abilities.

Conclusion: Application of FMEA principles to laparoscopy training can help acquire non-technical skills necessary for safe laparoscopic surgery.

Show MeSH