title: Simulated laparoscopic operating room crisis: An approach to enhance the surgical team performance.
abstract: OBJECTIVE
  Diminishing human error and improving patient outcomes is the goal of task training and simulation experience. The fundamentals of laparoscopic surgery (FLS) is a validated tool to assess technical laparoscopic skills. We hypothesize that performance in a crisis depends on technical skills and team performance. The aim of this study was to develop and validate a high-fidelity simulation model of a laparoscopic crisis scenario in a mock endosuite environment.
  
  
  METHODS
  To establish the feasibility of the model as well as its face and construct validity, the scenario evaluated the performances of FLS-certified surgeon experts (n = 5) and non-FLS certified novices (n = 5) during a laparoscopic crisis scenario, in a mock endosuite, on a simulated abdomen. Likert scale questionnaires were used for validity assessments. Groups were compared using previously validated rating scales on technical and nontechnical performance. Objective outcome measures assessed were: time to diagnose bleeding (TD), time to inform the team to convert (TT), and time to conversion to open (TC). SAS software was used for statistical analysis.
  
  
  RESULTS
  Median scores for face validity were 4.29, 4.43, 4.71 (maximum 5) for the FLS, non-FLS, and nursing groups, respectively, with an inter-rater reliability of 93%. Although no difference was observed in Veress needle safety and laparoscopic equipment set up, there was a significant difference between the two groups in their overall technical and nontechnical abilities (p < 0.05), specifically in identifying bleeding, controlling bleeding, team communication, and team skills. There was a trend towards a difference between the two groups for TD, TT, and TC. While experts controlled bleeding in a shorter time, they persisted longer laparoscopically.
  
  
  CONCLUSIONS
  Our evidence suggests that face and construct validity are established for a laparoscopic crisis simulation in a mock endosuite. Technical and nontechnical performance discrimination is observed between novices and experts. This innovative multidisciplinary simulation aims at improving error/problem recognition and timely initiation of appropriate and safe responses by surgical teams.
authors: Section of Minimally Invasive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA.
authors: Kinga A
authors: KA
authors: Powers
authors: Scott T
authors: ST
authors: Rehrig
authors: Noel
authors: N
authors: Irias
authors: Hedwig A
authors: HA
authors: Albano
authors: Andrew
authors: A
authors: Malinow
authors: Stephanie B
authors: SB
authors: Jones
authors: Donald W
authors: DW
authors: Moorman
authors: John B
authors: JB
authors: Pawlowski
authors: Daniel B
authors: DB
authors: Jones
mesh_terms: D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D002983:Clinical Competence; D005240:Feasibility Studies; D013502:General Surgery / Q000193:education*; D006470:Hemorrhage / Q000517:prevention & control; D006801:Humans; D007318:Inservice Training; D009873:Operating Rooms; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team; D016544:Patient Simulation; D015203:Reproducibility of Results