Can a structured checklist prevent problems with laparoscopic equipment?
BACKGROUND
A high incidence of problems with the technical equipment is known to occur during routine laparoscopic procedures. Use of a structured checklist of preparatory measures could help to prevent these problems. This study aimed to determine the extent to which a checklist reduced the number of incidents with technical laparoscopic equipment.


METHODS
A 28-item checklist was developed based on frequently occurring laparoscopic equipment problems during 30 laparoscopic cholecystectomies (the control group). A further 30 procedures were conducted with the checklist (the checklist group). The number and type of incidents with the technical equipment were compared between the groups. All the procedures were recorded using a special audio-video system (black-box).


RESULTS
In the checklist group, the total number of incidents per procedure was 53% lower than in the control group (23/30 versus 49/30). The checklist led to fewer incidents of wrong positioning (9/30 versus 22/30), and wrong settings and connections (7/30 versus 12/30) of the equipment. Defects or malfunctions decreased from 15/30 in the control group to 7/30 in the checklist group. One or more incidents with the equipment occurred in 47% (14/30) of the checklist procedures compared with 87% (26/30) of the control procedures. Median time taken to complete the checklist items was 3.3 min (range 1.0-8.3 min).


CONCLUSIONS
Use of a checklist was feasible and helped to reduce problems with the laparoscopic equipment in the operating room. Future research should aim to implement checklists for different procedures and investigate their effects.
Verdaasdonk
E G G
EG
Department of BioMechanical Engineering, Faculty of Mechanical, Maritime & Materials Engineering, Delft University of Technology, Delft, The Netherlands. e.g.g.verdaasdonk@tudelft.nl
Stassen
L P S
LP
Hoffmann
W F
WF
van der Elst
M
M
Dankelman
J
J
D017081:Cholecystectomy, Laparoscopic / Q000295:instrumentation*; D002985:Clinical Protocols; D004868:Equipment Failure; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000517:prevention & control; D020706:Laparoscopes / Q000009:adverse effects*