Biomedical subjects

P Joice

Publications and source records attributed to P Joice.

3 recordsLinked to original sources

PubMed2004

Identification and categorization of technical errors by Observational Clinical Human Reliability Assessment (OCHRA) during laparoscopic cholecystectomy.

HYPOTHESIS: Surgical operative performance benefits from analysis of the mechanisms underlying technical errors committed during surgery. DESIGN: Prospective study using the Observational Clinical Human Reliability Assessment (OCHRA) system and complete unedited videotapes of the operations. SETTING: Three National Health Service hospitals within the United Kingdom. PATIENTS: Two hundred consecutive patients with symptomatic gallstone disease. INTERVENTIONS: Elective laparoscopic cholecystectomy for symptomatic gallstone disease by surgeons, who were blind to the nature and objectives of the study, using their usual operative technique. MAIN OUTCOME MEASURES: Surgical consequential and inconsequential operative errors. RESULTS: The analysis of 38 062 steps of the 200 laparoscopic cholecystectomies performed by 26 surgeons identified 2242 errors. The mean +/- SD total, inconsequential, and consequential errors per surgical procedure were 11.0 +/- 8.0, 8.0 +/- 6.0, and 4.0 +/- 3.0, respectively. Dissection of the Calot triangle (second task zone of the operation) incurred more total errors (6.5 +/- 5.4) compared with the first (2.9 +/- 2.8, P<.001) and third (5.1 +/- 3.9, P<.05) task zones. This translated to a higher error probability (6.9% vs 3.5% for the first and 5.5% for third task zones). The combined sharp and blunt dissection method had fewer errors than the blunt/teasing dissection technique (9.45 +/- 7.6 vs 13.9 +/- 7.3, P<.001) although different surgeons were involved. The most serious consequences were encountered during dissection with the electrosurgical hook knife. CONCLUSION: This study has confirmed that the Observational Clinical Human Reliability Assessment system provides a comprehensive objective assessment of the quality of surgical operative performance by documenting the errors, the stage of the operation in which errors are enacted most frequently, and where these errors have serious consequences (hazard zones).

Cholecystectomy, Laparoscopic↗

PubMed1998

Ergonomic evaluation of laparoscopic bowel suturing.

BACKGROUND: Ergonomic assessment of the instrument to needle to tissue relationship on efficiency and accuracy of laparoscopic suturing. METHODS: Video records of nine laparoscopic surgeons were analyzed for five technical variables of laparoscopic suturing. Surgeons undertook closure of 60 mm enterotomy using continuous 3/0 seromuscular atraumatic sutures. Subjects attempted to suture 3 to 5 mm from enterotomy edge and at 3 to 5 mm intervals. Vertical/horizontal deviations from desired entry/exit point of suture, execution time, and failure to complete sutures were recorded. RESULTS: Visualization style used by some was significantly more accurate but slower than the nonvisualization style used by others. Needle insertion angle of 80 degrees to 100 degrees gripping the middle and proximal end of needle and holding the needle >90 degrees to instrument axis significantly improved task accuracy. Insertion angle <80 degrees produced three times the failure rate of 80 degrees to 100 degrees. Surgeon's performance was consistent with either suturing style. CONCLUSIONS: Visualization style was slower but more accurate. Optimum conditions for good suturing include 80 degrees to 100 degrees needle insertion angle; holding angle >90 degrees, and gripping point at middle and proximal third of the shaft of the needle. Task accuracy was surgeon dependent.

Colon↗

PubMed1998

Errors enacted during endoscopic surgery--a human reliability analysis.

The aim of the study was to document the nature and incidence of surgical errors enacted during laparoscopic surgery in order to direct future research and surgical training. A modified Human Reliability Analysis (HRA) approach, based on direct observation, was adopted to categorise and record errors encountered during the practice of laparoscopic cholecystectomy. This study confirmed the applicability and usefulness of an observational methodology in the assessment of human error in endoscopic surgical performance. The study identified aspects of the design and usage of instruments, surgical training and the differences between tasks which needed further directed research in order to identify underlying performance shaping factors (PSFs) and so reduce error rates.

Cholecystectomy↗