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Related Experiment Videos

Using human reliability analysis to detect surgical error in endoscopic DCR surgery.

R Malik1, P S White, C J Macewen

  • 1University Departments of Otolaryngology, Ninewells Hospital and Medical School, Dundee, UK.

Clinical Otolaryngology and Allied Sciences
|September 13, 2003
PubMed
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Skill-based errors in endoscopic dacryocystorhinostomy (DCR) surgery are common, particularly with instrument handling. Trainees should use less force during insertions, withdrawals, and incisions to prevent nasal mucosal trauma.

Area of Science:

  • Otolaryngology
  • Surgical Error Analysis
  • Human Factors Engineering

Background:

  • Endoscopic dacryocystorhinostomy (DCR) is a common surgical procedure.
  • Understanding skill-based errors is crucial for improving surgical safety and outcomes.

Purpose of the Study:

  • To identify and describe the nature of active skill-based errors in endoscopic DCR surgery.
  • To analyze the causes of nasal mucosal trauma during these procedures.

Main Methods:

  • Human reliability analysis methodology applied to observational data.
  • Video recording and detailed analysis of 12 endoscopic DCR surgeries performed by trainees.
  • Documentation of common errors, focusing on those causing mucosal trauma.

Main Results:

Related Experiment Videos

  • Execution errors were frequent, with grasping errors (often with Blakesley forceps) accounting for 67% of all execution errors.
  • A total of 69 mucosal trauma events were recorded.
  • Excessive force or speed during instrument insertion/withdrawal (over 50%) and forceful incisions causing 'overshoot' (34%) were primary causes of mucosal trauma.

Conclusions:

  • Trainee ENT surgeons must exercise caution with instrument handling, especially during insertion/withdrawal and incisions.
  • Applying excessive force is a key, avoidable cause of mucosal trauma in endoscopic DCR.
  • Further research into endoscopic sinus surgery instrument design is recommended to mitigate identified errors.