Dataset Information

Creation of a universal language for surgical procedures using the step-by-step framework.

ABSTRACT:

Background

Learning of surgical procedures is traditionally based on a master-apprentice model. Segmenting procedures into steps is commonly used to achieve an efficient manner of learning. Existing methods of segmenting procedures into steps, however, are procedure-specific and not standardized, hampering their application across different specialties and thus worldwide uptake. The aim of this study was to establish consensus on the step-by-step framework for standardizing the segmentation of surgical procedures into steps.

Methods

An international expert panel consisting of general, gastrointestinal and oncological surgeons was approached to establish consensus on the preciseness, novelty, usefulness and applicability of the proposed step-by-step framework through a Delphi technique. All statements were rated on a five-point Likert scale. A statement was accepted when the lower confidence limit was 3·00 or more. Qualitative comments were requested when a score of 3 or less was given.

Results

In round one, 20 of 49 experts participated. Eighteen of 19 statements were accepted; the 'novelty' statement needed further exploration (mean 3·05, 95 per cent c.i. 2·45 to 3·65). Based on the qualitative comments of round one, five clarifying statements were formulated for more specific statements in round two. Twenty-two experts participated and accepted all statements.

Conclusion

The international expert panel consisting of general, gastrointestinal and oncological surgeons supported the preciseness, usefulness and applicability of the step-by-step framework. This framework creates a universal language by standardizing the segmentation of surgical procedures into step-by-step descriptions based on anatomical structures, and may facilitate education, communication and assessment.

SUBMITTER: Nazari T

PROVIDER: S-EPMC5989977 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BACKGROUND:During the implementation of new interventions (i.e., surgical devices and technologies) in the operating room, surgical safety might be compromised. Current safety measures are insufficient in detecting safety hazards during this process. The aim of the study was to observe whether surgical teams are capable of measuring surgical safety, especially with regard to the introduction of new interventions. METHODS:A Surgical Safety Questionnaire was developed that had to be filled out directly postoperative by three surgical team members. A potential safety concern was defined as at least one answer between (strongly) disagree and indifferent. The validity of the questionnaire was assessed by comparison with the results from video analysis. Two different observers annotated the presence and effect of surgical flow disturbances during 40 laparoscopic hysterectomies performed between November 2010 and April 2012. RESULTS:The surgeon reported a potential safety concern in 16% (85/520 questions). With respect to the scrub nurse and anesthesiologist, this was both 9% (46/520). With respect to the preparation, functioning, and ease of use of the devices in 37.5-47.5% (15-19/40 procedures) a potential safety concern was reported by one or more team members. During procedures after which a potential safety concern was reported, surgical flow disturbances lasted a higher percentage of the procedure duration [9.3?±?6.2 vs. 2.9?±?3.7% (mean?±?SD), p?<?.001]. After procedures during which a new instrument or device was used, more potential safety concerns were reported (51.2 vs. 23.1%, p?<?.001). CONCLUSIONS:Potential safety concerns were especially reported during procedures in which a relatively high percentage of the duration consisted of surgical flow disturbances and during procedures in which a new instrument or device was used. The Surgical Safety Questionnaire can act as a validated tool to evaluate and maintain surgical safety during minimally invasive procedures, especially during the introduction of a new intervention.