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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.

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Related in: MedlinePlus

Percentage of surgeons committing failures during each phase for each OR session: a OR session 1, b OR session 2, c OR session 3. Surgical phase: 1 Fixation of patient to the operation table, 2 Trocar placement, 3 Obtaining surgical field, 4 Splenic flexure mobilisation, 5 Arterial pedicle dissection, 6 Ureter localization, 7a Proximal specimen division, 7b Distal specimen division, 8 Division of mesocolon, 9 Abdominal wall incision for specimen extraction, 10 Stapled anastomosis
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Related In: Results  -  Collection


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Fig2: Percentage of surgeons committing failures during each phase for each OR session: a OR session 1, b OR session 2, c OR session 3. Surgical phase: 1 Fixation of patient to the operation table, 2 Trocar placement, 3 Obtaining surgical field, 4 Splenic flexure mobilisation, 5 Arterial pedicle dissection, 6 Ureter localization, 7a Proximal specimen division, 7b Distal specimen division, 8 Division of mesocolon, 9 Abdominal wall incision for specimen extraction, 10 Stapled anastomosis

Mentions: In Fig. 2, we can observe the details of all types of failures committed by the trainees during all three OR sessions. We can observe a shift from the failures of proceeding type to the errors of technical type, the latter being the result of each participant laparoscopy skills prior to the course.Fig. 2


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)

Percentage of surgeons committing failures during each phase for each OR session: a OR session 1, b OR session 2, c OR session 3. Surgical phase: 1 Fixation of patient to the operation table, 2 Trocar placement, 3 Obtaining surgical field, 4 Splenic flexure mobilisation, 5 Arterial pedicle dissection, 6 Ureter localization, 7a Proximal specimen division, 7b Distal specimen division, 8 Division of mesocolon, 9 Abdominal wall incision for specimen extraction, 10 Stapled anastomosis
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig2: Percentage of surgeons committing failures during each phase for each OR session: a OR session 1, b OR session 2, c OR session 3. Surgical phase: 1 Fixation of patient to the operation table, 2 Trocar placement, 3 Obtaining surgical field, 4 Splenic flexure mobilisation, 5 Arterial pedicle dissection, 6 Ureter localization, 7a Proximal specimen division, 7b Distal specimen division, 8 Division of mesocolon, 9 Abdominal wall incision for specimen extraction, 10 Stapled anastomosis
Mentions: In Fig. 2, we can observe the details of all types of failures committed by the trainees during all three OR sessions. We can observe a shift from the failures of proceeding type to the errors of technical type, the latter being the result of each participant laparoscopy skills prior to the course.Fig. 2

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
Related in: MedlinePlus