Accident analysis: factors contributing to a ureteric injury during deep endometriosis surgery

Schonman R, R Schonman, Ron Schonman, Carlo De Cicco Nardone, C De Cicco, Corona R, Roberta Corona, R Corona, Soriano D, David Soriano, D Soriano, PR Koninckx, P R Koninckx, Koninckx PR
BJOG: An International Journal of Obstetrics & Gynaecology · 2008 · vol. 115(13) , pp. 1611–1615 · doi:10.1111/j.1471-0528.2008.01941.x · PMID:19035937 · W1966555632
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A retrospective analysis of a ureteric injury during deep endometriosis surgery identified uncontrolled bleeding and prolonged laser activation as contributing factors, potentially linked to fatigue-induced surgical acceleration.

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Abstract

OBJECTIVE: To analyse factors associated with a ureteric injury. DESIGN: Retrospective accident analysis. SETTING: Deep endometriosis surgery in a tertiary referral centre. SAMPLE: Video recording of a surgical accident was analysed by six gynaecologists. METHODS: A 26-year-old woman underwent laparoscopy for deep endometriosis that involves the rectosigmoid and left ureter. Post operatively left ureter transection was identified and corrected by laparoscopy. Interventions were recorded and reviewed independently. MAIN OUTCOME MEASURES: Changes in surgical behaviour that could be measured were identified using the video recording. Results During the intervention, the periods of uncontrolled bleeding (P < 0.0001) and the duration of laser activation (P = 0.013) increased progressively. Simultaneous laser activation and bipolar coagulation only occurred at the end of surgery (seven episodes). Fatigue could not be measured. CONCLUSION: Unconscious acceleration of surgery, possibly as a consequence of fatigue, is suggested as a contributing factor for an error of judgement.

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Laparoscopy Rectal Diseases Sigmoid Diseases Ureter Adult Endometriosis Female Humans Laparoscopy Laser Coagulation Laser Coagulation Medical Errors Postoperative Pain Postoperative Pain Rectal Diseases Sigmoid Diseases Ureter Ureter

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Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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