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Proficiency-gain curve for an advanced laparoscopic procedure defined by observation clinical human reliability assessment (OCHRA)

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Abstract

Background

There is no established method for defining when a surgeon reaches the proficiency plateau in performing a specific operation. The published literature refers to “learning curves” based on retrospective evaluation of operative time, conversion rates, morbidity etc., which lack objectivity and do not address individual human factors. A more useful study of the gain in proficiency by the individual surgeon for a particular operation may be obtained using observational clinical-human reliability assessment (OCHRA).

Methods

Following an 8-month fellowship in advanced laparoscopic surgery, the surgeon M.T. performed, independently at his own hospital, a prospective series of 20 palliative bypass operations for advanced gastric or pancreatic cancer. Unedited videotapes of gastro-jejunostomy (GJ) or cholecysto-jejunostomy (CJ) were analyzed independently in the training institution by the OCHRA technique.

Results

For this surgeon proficiency in executing laparoscopic palliative bypass was reached after the 14th anastomosis when efficient execution (reduction in operative time) was accompanied by significant reduction in technical errors and improved economy of movement (reduction of the economy of movement index from 7–5 to 3–2). The majority of errors were enacted in component tasks associated with intracorporeal suturing. The declining incidence of these errors with experience was an integral component of the proficiency-gain curve. The important performance-shaping factors identified were: concentration lapses (n = 1,321), misjudgments (n = 209), poor camera work (n = 193), fatigue (n = 128), and impaired coordination (n = 108).

Conclusions

This study has confirmed that OCHRA can describe quantitatively the proficiency-gain curve for a laparoscopic operation and indicate the plateau stage when the individual surgeon attains maximal performance in the execution of a specific procedure.

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References

  1. Cuschieri A (2003) Lest we forget the surgeon. Sem Lap Surg 10:141–148

    Google Scholar 

  2. Cuschieri A (2006) Nature of human error: implications for surgical practice. Ann Surg 244:642–648

    Article  PubMed  Google Scholar 

  3. Kirwan B. Human reliability assessment. In: Wilson JR, Corlett EN (eds) Evalutaion of human work: a practical metodology, 2nd edn. Taylor & Francis, London, pp 921–968

  4. Joice P, Hanna GB, Cuschieri A (1998) Errors during endoscopic surgery. A human reliability analysis. Appl Ergon 29:409–414

    Article  PubMed  CAS  Google Scholar 

  5. Tang B, Hanna GB, Joice P, Cuschieri A (2004) Identification and categorization of technical errors by observational clinical human reliability assessment (OCHRA) during laparoscopic cholecystectomy. Arch Surg 139:1215–1220

    Article  PubMed  CAS  Google Scholar 

  6. Reichenbach D, Tackett AD, Harris J, Diego C, Graviss EA, Dewan B, Vavra A, Stiles A, Fisher WE, Brunicardi FC, Sweeney JF (2006) Laparoscopic colon resection early on the learning curve. What is the appropriate setting? Ann Surg 243:730–737

    Article  PubMed  Google Scholar 

  7. O’Brien T, Tiptaft R, Glass J (2005) Defining the learning curves for percutaneous nephrolithotomy. J Urol 19:279–282

    Google Scholar 

  8. Bollens R, Sandhu S, Roumeguerre T, Quackela T, Shulman C (2005) Laparoscopic radical prostatectomy: the learning curve. Curr Opin Urol 15:79–92

    Article  PubMed  Google Scholar 

  9. Voitk AJ, Tsao SGS, Ignatius S (2001) The tail of the learning curve for laparoscopic cholecystectomy. Am J Surg 182:250–253

    Article  PubMed  CAS  Google Scholar 

  10. Archer SB, Brown DW, Smith D, Branum GD, Hunter JG (2001) Bile duct injury during laparoscopic cholecystectomy: results of a national survey. Ann Surg 234:549–559

    Article  PubMed  CAS  Google Scholar 

  11. Wruck D, Fleming I. Educational aspects of proficiency testing programs. http://www.caeal.ca/iad_PTCG(06)-17.pdf. Last accessed 15/03/07

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Authors and Affiliations

  1. Department of Surgery, Imam Khomeini Hospital, Tehran, Iran

    M. Talebpour & Z. Moosa

  2. Cuschieri Skills Centre, Ninewells Hospital, University of Dundee, Dundee, UK

    A. Alijani & B. Tang

  3. Imperial College, St. Mary’s Hospital, London, UK

    G. B. Hanna

  4. Institute for Medical Science and Technology, University of Dundee, Scotland and Scuola Superiore Sant’Anna, Pisa, Italy

    Alfred Cuschieri

  5. Institute for Medical Science and Technology, University of Dundee, Dundee Medipark, Dundee, DD2 1FD, UK

    Alfred Cuschieri

Authors
  1. M. Talebpour
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  2. A. Alijani
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  3. G. B. Hanna
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  4. Z. Moosa
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  5. B. Tang
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  6. Alfred Cuschieri
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Corresponding author

Correspondence to Alfred Cuschieri.

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Talebpour, M., Alijani, A., Hanna, G.B. et al. Proficiency-gain curve for an advanced laparoscopic procedure defined by observation clinical human reliability assessment (OCHRA). Surg Endosc 23, 869–875 (2009). https://doi.org/10.1007/s00464-008-0088-5

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  • DOI: https://doi.org/10.1007/s00464-008-0088-5

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