Mistakes and Errors in Minimal Access Surgery

 

Minimal access surgery (MAS) can be a lengthy procedure when compared to open surgery and therefore surgeon fatigue becomes an important issue and surgeons may expose themselves to chronic injuries and making mistakes and errors. There have been few studies on this topic of mistakes and errors in minimal access surgery and they have used only questionnaires and electromyography rather than direct measurement of energy expenditure. The aim of a good laparoscopic trainer and premier institute is to investigate whether the use of an armrest could reduce the mistakes and errors of laparoscopic surgeons during MAS.

Dr. R.K. Mishra has done extensive work to decrease the mistakes and errors in minimal access surgery. Some two decades after its introduction, minimal access surgery (MAS) is still fastly evolving. Undoubtedly in new era, its significant uptake world wide is due to its clinical benefits to very good patient surgical outcome. These benefits include reduced traumatic insult, reduction of pain, earlier return to bowel function, decrease disability, shorter hospitalization and better cosmetic results after laparoscopic surgery. Nonetheless complications due to the laparoscopic approach are not rare as documented by several studies on task specific or procedure related MAS morbidity.

In all these instances, laparoscopic surgery error analysis research carried out by World Laparoscopy Hospital has demonstrated that an understanding of the underlying causes of these complications requires a comprehensive approach addressing the entire surgical team and system related to the procedure for identification and characterization of the errors ultimately responsible for the morbidity of patient.

The work of a good team leader of minimal access surgery is to make a system which covers definition, taxonomy and incidence of errors in laparoscopic surgery with special reference to error reduction in MAS. In addition, possible root causes of adverse events in laparoscopy are explored by carefull and existing methods to study errors. Finally specific areas requiring further human factors research to enhance safety of patients undergoing advanced general surgical or gynecological laparoscopic surgery. The responsibility of a good laparoscopic surgeon is that awareness of causes and mechanisms of errors may reduce incidence of errors in clinical practice for the final benefit of the patients.

There are many possibility of Mistakes in Minimal Access Surgery. The first step in a laparoscopic procedure is to access the peritoneal cavity in order to establish pneumoperitoneum. One method of minimal surgical access, using the Veress needle, is considered the closed access technique. In veress need technoque after nasogastric suction and drainage of the urinary bladder, a stab incision is made at the umbilicus, followed by the blind passing of a Veress into the abdominal cavity. Position of the needle within the peritoneal cavity can be confirmed by aspiration through a water filled syringe and by the water drop test. Once the surgeon is comfortable that the needle is in the peritoneal cavity, pneumoperitoneum is established and trocars are inserted. During this insertion of veress needle and trocar a lot of mistakes are possible.

Safe method of access with less chance of mistake is the open technique. in open technique after making the umbilical skin incision, the laparoscopic surgeon incises the anterior abdominal fascia and the peritoneum under direct vision. The minimal access surgeon can then assess the peritoneal cavity for any adhesions prior to insertion of the first trocar.

The laparoscopic surgeon can either suture the fascia closed around the trocar or can use the wedge-shaped Hasson trocar to establish a seal in order to allow the development of pneumoperitoneum. Open technoque can minimize many mistakes and errors in Minimal Access Surgery.

If Mistake and Errors in Minimal Access Surgery is not minimized then in patients undergoing laparoscopic surgery, the rates of morbidity (12% to 25%) and the mortality (0% to 2.6%) appear to be similar to those obtained after open surgery. Intraoperative complications include bowel injury, injury to major vessels, injury to minor vessels and ureteric injury. If surgeon has knowledge of correct ergonomics and he will use correct task analysis during performing this minimal access surgery then these complication can be minimized.