Expert Intraoperative Judgment and Decision-Making: Defining the Cognitive Competencies for Safe Laparoscopic Cholecystectomy

Madani, Amin; Watanabe, Yusuke; Feldman, Liane S.; Vassiliou, Melina C.; Barkun, Jeffrey; Fried, Gerald M.; Aggarwal, Rajesh

doi:10.1016/j.jamcollsurg.2015.07.450

Cited by 39 publications

(30 citation statements)

References 55 publications

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“…However, cost is also a factor to consider for these alternatives of MRCP. In addition to this, intra-operative errors in perception, judgment, and decision-making occasionally cause bile duct injuries [17] So, we think that intraoperative procedures result in a higher risk on the surgeon's part, and if the surgeon and the radiologist were to examine the biliary anatomy together before surgery by using MRCP, this would reduce rate of surgical injury.…”

Section: Discussionmentioning

confidence: 99%

Anatomic Variations of Biliary Ducts: Magnetic Resonance Cholangiopancreatography Findings of 1041 Consecutive Patients

et al. 2016

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Background It is important for surgical purposes to know the biliary tract anatomy and its variations in detail. The aim of the study was to evaluate the frequency of anatomical variations of the biliary tract at hepatic bifurcation level and also at cystic duct level using magnetic resonance cholangiopancreatography (MRCP). Methods A total of 1041 patients (between 16 and 102 years of age, 600 women 441 men with mean age of 60.6) were included in the study. The MRCP imaging was carried out with a 1.5 Tesla magnetic resonance imaging (MRI) device by using heavily T2-weighted sequences. Results Among the 1041 patients included in the study, 424 (40.7 %) showed anatomical variations at different levels of the biliary tree, and 12 of these patients (1.15 %) had two anatomical variations. Typical anatomy was present in 57.2 % of the females and 62.1 % males. The highest incidence of variation at the level of bifurcation was trifurcation with 133 patients (12.8 %) and at the level of cystic duct was the medial cystic duct insertion with 56 patients (5.37 %). Conclusions Trifurcation and medial cystic duct insertion seem to be more frequent in females compared to males. It is necessary to have the knowledge of these variations to avoid possible complications and also help to achieve the most effective result. MRCP

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Section: Discussionmentioning

confidence: 99%

Anatomic Variations of Biliary Ducts: Magnetic Resonance Cholangiopancreatography Findings of 1041 Consecutive Patients

et al. 2016

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“…The surgeons with more than 5 years of experience in independent practice, who performed at least 100 LC or more than 75 cases annually are considered to be experts, and the surgeons with personal records of less than 100 LC as the first surgeons to be non-experts [81,82]. In addition, surgeon's specialization influences the incidence of CTO.…”

Section: Surgeon-related Risk Factorsmentioning

confidence: 99%

Risk Factors and Predictive Models for Conversion of Laparoscopic Cholecystectomy to Open Surgery, and Surgical Quality Outcome Measures

Beliaev¹,

Booth²

2016

Actual Problems of Emergency Abdominal Surgery

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Background: Laparoscopic cholecystectomy is the preferred surgical operation for symptomatic gallstone disease. Conversion of laparoscopic cholecystectomy to open surgery is used to prevent intra-abdominal organ injury, for open common bile duct exploration and to repair intra-abdominal organ injury. Objective:The objective of this chapter is to review risk factors and predictive models for conversion of laparoscopic cholecystectomy to open surgery, and surgical quality outcome measures. Methods:A narrative literature review using Pubmed, Medline, Cochrane library databases and Google search engine is described.Results: From the literature review, patient-and surgeon-related risk factors and predictive models for conversion of laparoscopic cholecystectomy to open surgery were identified. Patient-dependent risk factors included preoperative and intraoperative variables. Current conversion of laparoscopic cholecystectomy to open surgery predictive models use only patient-dependent risk factors and were not tested on an independent sample of patients. Surgical quality outcome measures incorporate an association between conversion and intra-abdominal organ injury that demonstrates that conversion was used as an emergency strategy to repair injuries rather than a safety measure. Conclusion:Conversion of laparoscopic cholecystectomy to open surgery risk stratification based on patient-and surgeon-dependent variables may allow a better management of the patient to keep conversion at low rates and to maintain benefits of minimally invasive surgery.

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“…Less commonly adverse events are being investigated as a part of surgical procedures, and those studies investigating surgical procedures have been restricted to genuine therapeutic errors such as e.g. the unwanted severance of the bile duct during laparoscopic cholecystectomy [14, 15].…”

Section: Introductionmentioning

confidence: 99%

Cognition errors in the treatment course of patients with anastomotic failure after colorectal resection

Vogel

2019

Patient Saf Surg

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BackgroundCognitive errors have a considerable effect on procedural outcome. They play a major role in situational judgement and decision making, especially during cognitively demanding tasks. As such they need to be considered an important factor in medical and surgical procedures. However, whereas cognitive diagnostic errors are well known, as of yet the occurrence of errors due to cognitive heuristics may have been downplayed, underestimated, or simply been ignored during the course of surgical treatment.MethodsAll colorectal resections with anastomosis in 2015 and 2016 (n = 230) were prospectively screened for anastomotic failure (n = 17/230). During structured Morbidity and Mortality Conferences (MMC) all anastomotic failures were analyzed for both tactical and technical decisions in the pre- and intraoperative setting with potential meaning for the postoperative course, based on the London Protocol. In order to demonstrate the significance of cognitive errors in surgical procedures a structured interview with the individual surgeon was conducted including the video and photo documentation of the individual surgical procedure. The interviews were coded by independent coders who were instructed to identify defined cognitive errors. Inter-coder agreement was calculated using Krippendorff’s alpha.ResultsIn 12/17 patients with anastomotic failure after colorectal surgery tactical or technical decisions with potential negative influence on anastomotic healing or the postoperative course were assessed during MMC. In 8/12 procedures a structured interview could be conducted with the operating surgeon. In 7/8 procedures cognitive errors could be identified. In particular we found Anchoring (n = 1), Availability Bias (n = 1), Commission Bias (n = 1), Overconfidence Bias (n = 1), Omission Bias (n = 2) and Sunk Costs (n = 1).ConclusionCognitive errors seem to play an important role during surgical therapy of patients with anastomotic failure after colorectal resection. Consequently, we suggest cognitive errors should attract more interest in research as well as attention in clinical practice.

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Expert Intraoperative Judgment and Decision-Making: Defining the Cognitive Competencies for Safe Laparoscopic Cholecystectomy

Cited by 39 publications

References 55 publications

Anatomic Variations of Biliary Ducts: Magnetic Resonance Cholangiopancreatography Findings of 1041 Consecutive Patients

Anatomic Variations of Biliary Ducts: Magnetic Resonance Cholangiopancreatography Findings of 1041 Consecutive Patients

Risk Factors and Predictive Models for Conversion of Laparoscopic Cholecystectomy to Open Surgery, and Surgical Quality Outcome Measures

Cognition errors in the treatment course of patients with anastomotic failure after colorectal resection

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