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Prospective cohort study on surgeons’ response to equipment failure in the laparoscopic environment

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Abstract

Background

Equipment malfunction accounts for approximately one-fourth of surgical errors in the operating room. A serious game was developed to train surgeons in recognizing and responding to equipment failure in minimally invasive surgery (MIS) adequately. This study determined the baseline performance of surgeons, surgical residents, surgical novices, and MIS equipment technicians in solving MIS equipment failure.

Methods

The serious game included 37 problem scenarios on the subjects lighting and imaging, insufflation and gas transport, electrosurgery, and pathophysiological disturbances. The scenarios were validated by laparoscopic surgeons and MIS equipment specialists. Forty-nine licensed surgeons, surgical residents, medical students, and MIS equipment specialists played four sessions on the serious game at a surgical convention. Scores on different outcome parameters were compared between groups of a different MIS experience.

Results

Laparoscopic equipment specialists solved significantly more MIS equipment-related problems than surgical novices, intermediates, and experts (68.9 vs. 51.0 %, 51.4, and 45.0 %, respectively, p = 0.01). Laparoscopic equipment specialists required significantly fewer steps to solve a problem accurately (median of 1.0 vs. 2.0 for the other groups). Most notably, experienced surgeons were unable to outperform novice and intermediate groups. Experienced surgeons took less time to solve the problems, but made more mistakes in doing so.

Conclusions

Experienced surgeons did not outperform inexperienced surgeons in dealing with laparoscopic equipment failure. These results are worrying and need to be addressed by the surgical community.

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Acknowledgments

The authors wish to thank the organizing committee of the annual convention of the Dutch Surgical Society for facilitating this study. The authors wish to thank Dr. S. Siregar from the Leiden University Medical Centre, dept. of Cardio-thoracic Surgery for contributing to the statistical analysis. The authors received funding from the Dutch Ministry of Economic Affairs (Grant ref PID 101060). This study was funded by the Dutch Ministry of Economic Affairs under grant reference PID 101060. The funding agency had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

Disclosures

Drs. Graafland, Prof. Bemelman, and Dr. Schijven have no conflicts of interest or financial ties to disclose.

Ethical approval

This study did not require approval of the local research ethics committee.

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Authors and Affiliations

  1. Department of Surgery, Academic Medical Centre, PO Box 22660, 1100 DD, Amsterdam, The Netherlands

    Maurits Graafland, Willem A. Bemelman & Marlies P. Schijven

Authors
  1. Maurits Graafland
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  2. Willem A. Bemelman
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  3. Marlies P. Schijven
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Correspondence to Marlies P. Schijven.

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Graafland, M., Bemelman, W.A. & Schijven, M.P. Prospective cohort study on surgeons’ response to equipment failure in the laparoscopic environment. Surg Endosc 28, 2695–2701 (2014). https://doi.org/10.1007/s00464-014-3530-x

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  • DOI: https://doi.org/10.1007/s00464-014-3530-x

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