Courdier Sébastien, Garbin Olivier, Hummel Michel, Thoma Véronique, Ball Elizabeth, Favre Romain, Wattiez Arnaud
Department of Gynecology, Centre Médico-Chirurgical et Obstétrical - Syndicat Inter-Hospitalier de la Communauté Urbaine de Strasbourg Hospital, University Hospital of Strasbourg, Schiltigheim, France.
J Minim Invasive Gynecol. 2009 Jan-Feb;16(1):28-33. doi: 10.1016/j.jmig.2008.08.019. Epub 2008 Nov 11.
To determine the incidence of equipment failure in gynecologic endoscopy and investigate causes and consequences.
A prospective observational single-center study between January and April 2006.
Gynecologic surgery department of a university hospital.
In all, 116 endoscopic interventions were included: 62 laparoscopies, 51 operative hysteroscopies, and 3 fertiloscopies. Emergency and equipment testing procedures were excluded.
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.
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.
确定妇科内镜检查中设备故障的发生率，并调查其原因及后果。
2006年1月至4月间进行的一项前瞻性单中心观察性研究。
一所大学医院的妇科手术科室。
共纳入116例内镜手术：62例腹腔镜手术、51例宫腔镜手术和3例输卵管镜检查。排除急诊手术和设备测试程序。
设备故障在成像、液体和光线传输、电路以及手术器械方面分为4类。我们还发现了部件之间连接错误的情况。分析了包括人为失误、时间损失以及实际或潜在后果等因素。在38.8%的手术操作、41.9%的腹腔镜手术和37.3%的宫腔镜手术中至少发现1次设备故障。液体、气体和光线传输故障占36.2%，手术器械故障占29.3%，电路故障占22.4%，成像故障占12.1%。在故障中，46.6%是由于两个部件之间连接错误所致。最常见的问题原因是腹腔镜手术中的双极电凝钳和电缆（42.3%）以及宫腔镜手术中的小部件组装（47.4%）。43%的病例涉及工作人员（72%为护士，12%为外科医生，16%两者均涉及）。一次设备故障使腹腔镜手术总时长增加7%，宫腔镜手术增加20%。因设备故障导致的平均延迟为5.6±4.0分钟。在这些发生率中，19%可能导致患者出现严重并发症；然而，本系列研究中实际未发生任何发病或死亡情况。
设备故障在内镜手术中很常见，腹腔镜手术和宫腔镜手术均受影响。后果可能很严重。必须识别并纠正设备故障的原因，以优化内镜器械的日常使用并提高患者安全性。目前正在评估系统检查表的实施情况。
