Comment on: Surgical experience and identification of errors in laparoscopic cholecystectomy
Year: 2024
Type: letter
Abstract: Dear Editor We read with interest and commend the recent publication from Humm et al.1 on the important topic of intraoperative error identification. No significant difference in the recognition of errors, by assessors of varying seniority, during laparoscopic cholecystectomy was found, but rather a difference in the error classification. There are several unaddressed considerations with the reported findings. First, most errors were classified as executional. While recognizing the correlation between technical skill and outcome, we must not underestimate cognitive task errors. This is particularly relevant in laparoscopic cholecystectomy, where cognitive bias may exacerbate misinterpretation of anatomy, resulting in bile duct injury. Although the authors recognize the limitations of video and participant numbers, the experience of the latter may have adversely affected the results. Junior trainees, while recognizing errors, may have lacked sufficient knowledge and experience to appreciate how they occurred. This is reflected in the classification of errors during dissection of the hepatocystic triangle, where consultants and senior trainees had commonality in their error classification as opposed to juniors. Given that dissection plane interpretation represents a cognitive task, it is surprising that pan-grade, incorrect dissection plane was identified as an executional error during ligation/division of the cystic structures. Factors that influenced classifications are varied and this finding highlights the subjectivity of error causes during laparoscopic cholecystectomy. This is an important consideration given the potential implications for feedback and training. With the recent advances in artificial intelligence (AI), it may not be long until there is routine use of automated error classification in surgery. AI will undoubtedly bring additional challenges to an already complex landscape, but may also offer exciting opportunities for standardization of intraoperative error terminology, enhanced understanding of underlying causes, and the development of impactful educational strategies to reduce error and improve outcomes. Lachlan Dick (Conceptualization, Writing—original draft, Writing—review & editing), Vicky Ruth Tallentire (Writing—review & editing), Richard JE Skipworth (Writing—review & editing) and Steven Yule (Writing—review & editing)
Source: British journal of surgery
DOI: 10.1093/bjs/znae030
Institutions: NHS Lothian, University of Edinburgh
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4392120218