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Erschienen in:

01.04.2008

Simulated laparoscopic operating room crisis: An approach to enhance the surgical team performance

verfasst von: Kinga A. Powers, Scott T. Rehrig, Noel Irias, Hedwig A. Albano, Andrew Malinow, Stephanie B. Jones, Donald W. Moorman, John B. Pawlowski, Daniel B. Jones

Erschienen in: Surgical Endoscopy | Ausgabe 4/2008

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Abstract

Objective

Diminishing human error and improving patient outcomes is the goal of task training and simulation experience. The fundamentals of laparoscopic surgery (FLS) is a validated tool to assess technical laparoscopic skills. We hypothesize that performance in a crisis depends on technical skills and team performance. The aim of this study was to develop and validate a high-fidelity simulation model of a laparoscopic crisis scenario in a mock endosuite environment.

Methods

To establish the feasibility of the model as well as its face and construct validity, the scenario evaluated the performances of FLS-certified surgeon experts (n = 5) and non-FLS certified novices (n = 5) during a laparoscopic crisis scenario, in a mock endosuite, on a simulated abdomen. Likert scale questionnaires were used for validity assessments. Groups were compared using previously validated rating scales on technical and nontechnical performance. Objective outcome measures assessed were: time to diagnose bleeding (TD), time to inform the team to convert (TT), and time to conversion to open (TC). SAS software was used for statistical analysis.

Results

Median scores for face validity were 4.29, 4.43, 4.71 (maximum 5) for the FLS, non-FLS, and nursing groups, respectively, with an inter-rater reliability of 93%. Although no difference was observed in Veress needle safety and laparoscopic equipment set up, there was a significant difference between the two groups in their overall technical and nontechnical abilities (p < 0.05), specifically in identifying bleeding, controlling bleeding, team communication, and team skills. There was a trend towards a difference between the two groups for TD, TT, and TC. While experts controlled bleeding in a shorter time, they persisted longer laparoscopically.

Conclusions

Our evidence suggests that face and construct validity are established for a laparoscopic crisis simulation in a mock endosuite. Technical and nontechnical performance discrimination is observed between novices and experts. This innovative multidisciplinary simulation aims at improving error/problem recognition and timely initiation of appropriate and safe responses by surgical teams.

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Titel: Simulated laparoscopic operating room crisis: An approach to enhance the surgical team performance
verfasst von: Kinga A. Powers
Scott T. Rehrig
Noel Irias
Hedwig A. Albano
Andrew Malinow
Stephanie B. Jones
Donald W. Moorman
John B. Pawlowski
Daniel B. Jones
Publikationsdatum: 01.04.2008
Verlag: Springer-Verlag
Erschienen in: Surgical Endoscopy / Ausgabe 4/2008
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-007-9678-x

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Abstract

Objective

Methods

Results

Conclusions

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