Application of Failure Mode and Effect Analysis in Laparoscopic Colon Surgery Training

Abstract

Aim To evaluate if application of failure mode and effect analysis (FMEA) to laparoscopy training can help surgeons acquire laparoscopy skills.MethodsAfter 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.ResultsWe 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.ConclusionApplication of FMEA principles to laparoscopy training can help acquire non-technical skills necessary for safe laparoscopic surgery.

Failure mode and effects analysis: a comparison of two common risk prioritisation methods

“…However, when examined closely, there is significant variation in the scoring, and therefore, prioritisation of failures 10 18 26 27 29–32. To our knowledge, there has been no prior comparison of any simplified scoring method with the traditional method.…”

“…The top 20% of failures by CI were designated ‘critical’ based on the Pareto Principle (80/20 rule) 25. An RPN of 300 was chosen as a threshold above which failure modes would be designated ‘critical’ based on prior literature and research team consensus 26 27…”

Development and content validation of the Urethroplasty Training and Assessment Tool (UTAT) for dorsal onlay buccal mucosa graft urethroplasty

“…In a surgical setting, HFMEA has been used to improve patient safety in laparoscopy and ophthalmic surgery . HFMEA has also been used to reduce medication error harm events in paediatric anaesthesia .…”

Porcine Model In The Laparoscopic Liver Surgery Training

“…Also in a recent study by our group we have shown that concentrating on evitable errors during colorectal laparoscopy training in pigs can yield better results than traditional training which focus on technical aspects of laparoscopy. With our approach we were able to obtain interesting results even with low number of repetition, which translates into fewer experimental animals that need to be operated in order to train one trainee (1).…”

“…The rise of minimally invasive procedures has increased the interest of many surgeons in laparo-and endoscopy training models that use live animal. As a result, pigs have been frequently used as a model for colorectal laparoscopic surgery (1), sheep as a gynecologic and transvaginal NOTES model (2) and rabbit as a pediatric thoracoscopy model (3). Indeed, the introduction of a new technique based on animal experiment can lead to steeper learning curve (1) and finally to less complications in humans after clinical application of the technique (4).…”