Laparoscopic cholecystectomy: device-related errors revealed through a national database

Abstract

Laparoscopic techniques represent a key milestone in the development of modern surgery, offering a step change in quality of care, patient satisfaction and efficiency in use of health service resources. Laparoscopy is most widely used for gall bladder surgery. As would be expected with the introduction of any new technology, the early phase of development was accompanied by complications in its use. Arguably some of these should have been anticipated, but nevertheless standards and training programs were subsequently put in place to secure a more consistent standard of care across the UK. Now that this early learning curve has largely been negotiated, we wanted to examine the nature of the errors associated with laparoscopic gall bladder surgery, particularly in relation to equipment. We used data from the largest error-reporting system in the world to examine the problem of equipment-related incidents amongst patients who had laparoscopic cholecystectomy. Over the 6-year period 2004–2010, the number of such reports increased 15-fold, whilst the growth in use of the procedure itself increased 1.3-fold. The majority of the increase was in device-related errors. User-related errors constituted a smaller proportion of errors. Whilst most surgeons appear to carry out laparoscopic surgery with a low level of harm to their patients, problems with their equipment remains a risk for many procedures. In some ways, this is an easier problem to address than one associated with competency. A risk associated with faulty, substandard or misused equipment is one that should be minimized in a 21st Century surgical service.

Keywords::

• equipment errors
• harm
• medical error
• patient safety
• risk

Contributors

Sukhmeet S Panesar, Sarah A Salvilla and Bhavesh Patel were responsible for the collection, extraction, analysis and interpretation of the data. Sukhmeet S Panesar and Sarah A Salvilla were responsible for manuscript drafting of the earlier versions of this article. Liam Donaldson was responsible for conception of the study, providing important intellectual content throughout the manuscript’s production and for approval of the final version. All authors have made substantial contributions to the conception and design of the study, or acquisition of data, or analysis and interpretation of data; the drafting of the article or revising it critically for important intellectual content; and the final approval of the version to be submitted.

Financial & competing interests disclosure

This study was undertaken as part of ongoing research at the National Patient Safety Agency, and did not receive separate funding. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Notes

Incidents reported to National Reporting and Learning System.