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

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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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Acknowledgements

The project was supported in part by the Carl J. Shapiro Institute for Education and Research. This study also relied on the generous contribution from Beth Israel Deaconess Medical Center’s operating room nursing staff. Acknowledgement goes out to David M. Feinstein MD and Diana Wood MD from the Department of Anesthesia, who generously volunteered their time to assist with the simulation project. The authors would also like to acknowledge the help of Anna C. Johansson Ph.D. and V.T. Zakrzewski Ph.D. for their expertise and help in questionnaire design and statistical analysis.

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Correspondence to Daniel B. Jones.

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Powers, K.A., Rehrig, S.T., Irias, N. et al. Simulated laparoscopic operating room crisis: An approach to enhance the surgical team performance. Surg Endosc 22, 885–900 (2008). https://doi.org/10.1007/s00464-007-9678-x

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  • DOI: https://doi.org/10.1007/s00464-007-9678-x

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