Avoiding complications of laparoscopic surgery: lessons from cognitive science and crew resource management

Complications may occur during laparoscopic surgery, even with a skilled surgeon and under ideal circumstances, because human error is inevitable. We reviewed videotaped procedures where malpractice was alleged and resolved in court to evaluate potential contributing factors. We evaluated possible sources of complications related to cognitive science, systems error, equipment issues, and surgeon selection and training. The way the human brain's hard-wiring shapes information processing, as well as perceptual learning, can influence the risk of surgical complications. Situation awareness and principles derived from aviation crew resource management may be adapted to help avoid systems error. The current process used to select gynecologic surgeons and the structure of surgical training may need to be reconsidered.