Designing safety into the minimally invasive surgical revolution

Abstract

Surgical errors with minimally invasive surgery differ from those in open surgery. Perforations are typically the result of trocar introduction or electrosurgery. Infections include bioburdens, notably enteric viruses, on complex instruments. Retained foreign objects are primarily unretrieved device fragments and lost gallstones or other specimens. Fires and burns come from illuminated ends of fiber-optic cables and from electrosurgery. Pressure ischemia is more likely with longer endoscopic surgical procedures. Gas emboli can occur. Minimally invasive surgery is more dependent on complex equipment, with high likelihood of failures. Standardization, checklists, and problem reporting are solutions for minimizing failures. The necessity of electrosurgery makes education about best electrosurgical practices important. The recording of minimally invasive surgical procedures is an opportunity to debrief in a way that improves the reliability of future procedures. Safety depends on reliability, designing systems to withstand inevitable human errors. Safe systems are characterized by a commitment to safety, formal protocols for communications, teamwork, standardization around best practice, and reporting of problems for improvement of the system. Teamwork requires shared goals, mental models, and situational awareness in order to facilitate mutual monitoring and backup. An effective team has a flat hierarchy; team members are empowered to speak up if they are concerned about problems. Effective teams plan, rehearse, distribute the workload, and debrief. Surgeons doing minimally invasive surgery have a unique opportunity to incorporate the principles of safety into the development of their discipline.

Torque Measurement During Body Cavity Entry Using A Threaded Visual Cannula

“…As a result, teaching safe application of laparoscopic ports in general remains arbitrary and application of excessive force during port creation leads to a significant number of trocar-related injuries. Reports from the US FDA describe 1353 serious injuries and 31 deaths over 5.5 years as a result of sharp-ended trocar use in MIS [17]. In an attempt to better understand this relationship, Passeroti et al [11] describe an apparatus capable of measuring linear force during body cavity entry using a sharp-ended access device.…”

Minimally invasive surgical technologies: Challenges in education and training

“…JR Clarke, the clinical director of the Pennsylvania Patient Safety Reporting System, oversees the analysis of approximately 5000 reports of medical errors that occur every week in the state of Pennsylvania (7). Although 97% of these reports indicate errors without harm, these safety issues still must be addressed, especially when considering the different obstacles encountered during all forms of minimally invasive surgery (MIS) and open surgery (e.g.…”