title: Human error identification for laparoscopic surgery: Development of a motion economy perspective.
abstract: This study postulates that traditional human error identification techniques fail to consider motion economy principles and, accordingly, their applicability in operating theatres may be limited. This study addresses this gap in the literature with a dual aim. First, it identifies the principles of motion economy that suit the operative environment and second, it develops a new error mode taxonomy for human error identification techniques which recognises motion economy deficiencies affecting the performance of surgeons and predisposing them to errors. A total of 30 principles of motion economy were developed and categorised into five areas. A hierarchical task analysis was used to break down main tasks of a urological laparoscopic surgery (hand-assisted laparoscopic nephrectomy) to their elements and the new taxonomy was used to identify errors and their root causes resulting from violation of motion economy principles. The approach was prospectively tested in 12 observed laparoscopic surgeries performed by 5 experienced surgeons. A total of 86 errors were identified and linked to the motion economy deficiencies. Results indicate the developed methodology is promising. Our methodology allows error prevention in surgery and the developed set of motion economy principles could be useful for training surgeons on motion economy principles.
authors.affiliation: School of Information Technology and Mathematical Sciences, University of South Australia, Australia. Electronic address: Latif.al-hakim@unisa.edu.au.
authors.forename: Latif
authors.initials: L
authors.lastname: Al-Hakim
authors.affiliation: Health Service & Population Research Department, King's College, London, UK.
authors.forename: Nick
authors.initials: N
authors.lastname: Sevdalis
authors.affiliation: Oncology Department, Bangkok Hospital, Bangkok, Thailand.
authors.forename: Tanaphon
authors.initials: T
authors.lastname: Maiping
authors.affiliation: Urology Centre, Bangkok Hospital, Bangkok, Thailand.
authors.forename: Damrongpan
authors.initials: D
authors.lastname: Watanachote
authors.affiliation: Austin Department of Surgery, University of Melbourne, Melbourne, Australia.
authors.forename: Shomik
authors.initials: S
authors.lastname: Sengupta
authors.affiliation: Urology Centre, Bangkok Hospital, Bangkok, Thailand.
authors.forename: Charuspong
authors.initials: C
authors.lastname: Dissaranan
mesh_terms: D006804:Ergonomics; D006801:Humans; D010535:Laparoscopy / Q000592:standards*; D019300:Medical Errors / Q000517:prevention & control*; D009038:Motion; D009068:Movement
keywords: Human error identification technique; Laparoscopic surgery; Motion economy