Abstract
Background
Laparoscopic rectal resection is technically challenging, with outcomes dependent upon technical performance. No robust objective assessment tool exists for laparoscopic rectal resection surgery. This study aimed to investigate the application of the objective clinical human reliability analysis (OCHRA) technique for assessing technical performance of laparoscopic rectal surgery and explore the validity and reliability of this technique.
Methods
Laparoscopic rectal cancer resection operations were described in the format of a hierarchical task analysis. Potential technical errors were defined. The OCHRA technique was used to identify technical errors enacted in videos of twenty consecutive laparoscopic rectal cancer resection operations from a single site. The procedural task, spatial location, and circumstances of all identified errors were logged. Clinical validity was assessed through correlation with clinical outcomes; reliability was assessed by test–retest.
Results
A total of 335 execution errors identified, with a median 15 per operation. More errors were observed during pelvic tasks compared with abdominal tasks (p < 0.001). Within the pelvis, more errors were observed during dissection on the right side than the left (p = 0.03). Test–retest confirmed reliability (r = 0.97, p < 0.001). A significant correlation was observed between error frequency and mesorectal specimen quality (r s = 0.52, p = 0.02) and with blood loss (r s = 0.609, p = 0.004).
Conclusions
OCHRA offers a valid and reliable method for evaluating technical performance of laparoscopic rectal surgery.
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Acknowledgments
The authors would like to thank the following experts who participated in the qualitative interviews that were used for development of the task analysis: Professor Willem Bemelman, Mr Mark Coleman, Professor Conor Delaney, Mr Mark Gudgeon, Dr Hitoshi Hasegawa, Professor Robin Kennedy, Professor Wai Lun Law, Professor Roger Motson, Professor Yves Panis, Professor Timothy Rockall, and Professor Steven Wexner.
Funding
This work was supported by the UK National Institute for Health Research, through the Research for Patient Benefit Programme (Grant Number PB-PG-1010-23326). The funding body did not have any role in the planning of the study, recruitment, data collection, or analysis.
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The authors declare that they have no conflict of interest.
Ethical approval
The study was approved by the South West England Research Ethics Committee (reference 12/SW/0278).
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Written consent was obtained from all patients and also surgeons for the recording and analysis of operations.
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Foster, J.D., Miskovic, D., Allison, A.S. et al. Application of objective clinical human reliability analysis (OCHRA) in assessment of technical performance in laparoscopic rectal cancer surgery. Tech Coloproctol 20, 361–367 (2016). https://doi.org/10.1007/s10151-016-1444-4
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DOI: https://doi.org/10.1007/s10151-016-1444-4