title: Equipment failure: causes and consequences in endoscopic gynecologic surgery.
abstract: OBJECTIVE
  To determine the incidence of equipment failure in gynecologic endoscopy and investigate causes and consequences.
  
  
  METHODS
  A prospective observational single-center study between January and April 2006.
  
  
  METHODS
  Gynecologic surgery department of a university hospital.
  
  
  METHODS
  In all, 116 endoscopic interventions were included: 62 laparoscopies, 51 operative hysteroscopies, and 3 fertiloscopies. Emergency and equipment testing procedures were excluded.
  
  
  RESULTS
  Equipment malfunctions were divided into 4 categories with regard to imaging, transmission of fluids and light, the electric circuit, and surgical instruments. We also found cases with faulty connections between elements. Factors including human error, loss of time, and actual or potential consequences were analyzed. At least 1 equipment failure was noted in 38.8% of operative procedures, 41.9% of laparoscopies, and 37.3% of hysteroscopies. Fluid, gas, and light transmission was faulty in 36.2%, surgical instruments in 29.3%, the electric circuit in 22.4%, and imaging in 12.1%. Of malfunctions, 46.6% were a result of faulty connection between 2 elements. The most common cause for concern was bipolar forceps and cables in laparoscopy (42.3%) and the assembly of small parts in hysteroscopy (47.4%). Personnel were implicated in 43% of cases (nurses in 72%, surgeons in 12%, both in 16%). One equipment failure increased the total duration of laparoscopy by 7% and of hysteroscopy by 20%. The mean delay was 5.6+/-4.0minutes by equipment failure. Of the incidences, 19% could have led to serious complications for the patient; however, no morbidity or mortality actually occurred in this series.
  
  
  CONCLUSIONS
  Equipment malfunction is common in endoscopic surgery and concerns both laparoscopy and hysteroscopy. Consequences are potentially serious. It is mandatory to identify and rectify causes of equipment failure so as to optimize the daily use of endoscopic instruments and improve patient safety. The implementation of systematic checklists is currently under evaluation.
authors.affiliation: Department of Gynecology, Centre Médico-Chirurgical et Obstétrical - Syndicat Inter-Hospitalier de la Communauté Urbaine de Strasbourg Hospital, University Hospital of Strasbourg, Schiltigheim, France. sebastien.courdier@sihcus.fr
authors.forename: Sébastien
authors.initials: S
authors.lastname: Courdier
authors.forename: Olivier
authors.initials: O
authors.lastname: Garbin
authors.forename: Michel
authors.initials: M
authors.lastname: Hummel
authors.forename: Véronique
authors.initials: V
authors.lastname: Thoma
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Ball
authors.forename: Romain
authors.initials: R
authors.lastname: Favre
authors.forename: Arnaud
authors.initials: A
authors.lastname: Wattiez
mesh_terms: D004868:Equipment Failure; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation*; D006785:Hospitals, University; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D011446:Prospective Studies; D012308:Risk Management; D013525:Surgical Instruments / Q000009:adverse effects*