Skip to main content
SpringerLink
Log in

Identification of technical errors and hazard zones in sleeve gastrectomy using OCHRA

“OCHRA for sleeve gastrectomy”

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

The sleeve gastrectomy is an example of minimally invasive surgery. It is important to determine the critical steps of the procedure in order to reduce complications and increase safety and efficiency.

Objective

The aim of this study was to detect the key elements of the sleeve gastrectomy and find the potential hazard zones of the procedure.

Setting

Bariatric department of a large teaching hospital in the Netherlands.

Methods

A prospective clinical observation study was performed including 60 sleeve gastrectomy procedures. An expert panel determined the key steps, and two experts assessed the procedures systematically for technical errors according to the principles of Observational Clinical Human Reliability Assessment (OCHRA).

Results

A total of 213 technical errors have been made, and the majority were made during mobilization of the greater curvature and during stapling of the stomach. In 44.6 %, errors had consequences and 96 additional actions were performed. There was a significant correlation between errors during opening of the lesser sac and postoperative complications, and between repositioning of the stapler and postoperative complications.

Conclusions

In this study, the 13 key steps of the SG were defined, and OCHRA was considered a valuable assessment tool for surgical performance and potential hazard zones. Most consequential errors are made during dissection of the greater curvature and during stapling of the stomach. Errors during the start of mobilization of the greater curvature and repositioning of the stapler lead to longer duration of the procedure and are associated with a higher risk of postoperative complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Sjöström L (2008) Bariatric surgery and reduction in morbidity and mortality: experiences from the SOS study. Int J Obes. 2008(32):S93–S97. doi:10.1038/ijo.2008.244

    Article  Google Scholar 

  2. Colquitt JL, Pickett K, Loveman E, Frampton GK (2014) Surgery for weight loss in adults. Cochrane database Syst Rev. 8(8):CD003641. doi:10.1002/14651858.CD003641.pub4

    Google Scholar 

  3. Helmiö M, Victorzon M, Ovaska J et al (2014) Comparison of short-term outcome of laparoscopic sleeve gastrectomy and gastric bypass in the treatment of morbid obesity: a prospective randomized controlled multicenter SLEEVEPASS study with 6-month follow-up. Scand J Surg 103(3):175–181. doi:10.1177/1457496913509984

    Article  PubMed  Google Scholar 

  4. Fischer L, Hildebrandt C, Bruckner T et al (2012) Excessive weight loss after sleeve gastrectomy: a systematic review. Obes Surg 22:721–731. doi:10.1007/s11695-012-0616-1

    Article  PubMed  Google Scholar 

  5. Clinical A, Committee I (2012) Updated position statement on sleeve gastrectomy as a bariatric procedure. Surg Obes Relat Dis 8(3):e21–e26. doi:10.1016/j.soard.2012.02.001

    Article  Google Scholar 

  6. 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(11):1215–1220. doi:10.1001/archsurg.139.11.1215

    Article  CAS  PubMed  Google Scholar 

  7. Cuschieri A, Tang B (2010) Human reliability analysis (HRA) techniques and observational clinical HRA. Minim Invasive Ther Allied Technol 19(1):12–17. doi:10.3109/13645700903492944

    Article  PubMed  Google Scholar 

  8. Miskovic D, Ni M, Wyles SM, Parvaiz A, Hanna GB (2012) Observational clinical human reliability analysis (OCHRA) for competency assessment in laparoscopic colorectal surgery at the specialist level. Surg Endosc 26(3):796–803. doi:10.1007/s00464-011-1955-z

    Article  PubMed  Google Scholar 

  9. Kehlet H, Wilmore DW (2005) Fast-track surgery. Br J Surg 92(1):3–4. doi:10.1002/bjs.4841

    Article  CAS  PubMed  Google Scholar 

  10. Jacobsen HJ, Bergland A, Raeder J, Gislason HG (2012) High-volume bariatric surgery in a single center: safety, quality, cost-efficacy and teaching aspects in 2,000 consecutive cases. Obes Surg 22(1):158–166. doi:10.1007/s11695-011-0557-0

    Article  CAS  PubMed  Google Scholar 

  11. Leape LL, Brennan TA, Laird N, Lawthers AG, Localio AR, Barnes BA, Hiatt. H (1991) The nature of adverse events in hospitalized patients: results of the Harvard medical practice study II. N Engl J Med 324(6):377–384

    Article  CAS  PubMed  Google Scholar 

  12. Baker GR, Norton PG, Flintoft V et al (2004) The Canadian adverse events study: the incidence of adverse events among hospital patients in Canada. CMAJ 170(11):1678–1686. doi:10.1503/cmaj.1040498

    Article  PubMed  PubMed Central  Google Scholar 

  13. de Vries EN, Ramrattan MA, Smorenburg SM, Gouma DJ, Boermeester MA (2008) The incidence and nature of in-hospital adverse events: a systematic review. Qual Saf Health Care. 17(3):216–223

    Article  PubMed  PubMed Central  Google Scholar 

  14. Cuschieri A (2005) Reducing errors in the operating room: surgical proficiency and quality assurance of execution. Surg Endosc Other Interv Tech 19(8):1022–1027. doi:10.1007/s00464-005-8110-7

    Article  CAS  Google Scholar 

  15. Cuschieri A (2006) Nature of human error. Ann Surg 244(5):642–648. doi:10.1097/01.sla.0000243601.36582.18

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands

    PWJ van Rutte, SW Nienhuijs, JJ Jakimowicz & G van Montfort

  2. Technical University of Delft, Delft, The Netherlands

    JJ Jakimowicz

Authors
  1. PWJ van Rutte
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. SW Nienhuijs
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. JJ Jakimowicz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. G van Montfort
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to PWJ van Rutte.

Ethics declarations

Disclosures

PWJ van Rutte MD, SW Nienhuijs MD PhD, JJ Jakimowicz MD PhD FRCS ED, and G van Montfort MD have no conflicts of interest or financial ties to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

van Rutte, P., Nienhuijs, S., Jakimowicz, J. et al. Identification of technical errors and hazard zones in sleeve gastrectomy using OCHRA. Surg Endosc 31, 561–566 (2017). https://doi.org/10.1007/s00464-016-4997-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-016-4997-4

Keywords

Search

Navigation