Download PDF
Clin Colon Rectal Surg 2021; 34(03): 131-135
DOI: 10.1055/s-0040-1718688
Review Article

Value of Nontechnical Skills in Minimally Invasive Surgery

Sergio Eduardo Alonso Araujo
1   Hospital Israelita Albert Einstein, São Paulo, Brasil
,
Nam Jin Kim
1   Hospital Israelita Albert Einstein, São Paulo, Brasil
,
Neto Miguel Cendoroglo
1   Hospital Israelita Albert Einstein, São Paulo, Brasil
,
Sidney Klajner
1   Hospital Israelita Albert Einstein, São Paulo, Brasil
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Nontechnical skills are of increasing importance in surgery and surgical training. The main studies on its impact on the safety and effectiveness of surgical interventions were mainly published in the first decade of the 2000s. Due to the significant technical complexity and great diversity of instruments for nontechnical skills evaluation, the interest in training and in measuring the impact on surgical safety has relatively decreased. However, the advent of minimally invasive surgery and its peculiar technical characteristics of sophisticated technique and constant innovation through the adoption of new materials and drugs has rekindled interest in this expertise area.

In the present review, we have revisited the main instruments available to measure nontechnical skill of surgical teams and analyzed the role of the main competencies on which they are based, such as situational awareness, leadership and communication skills, and the consistency of the intraoperative decision-making process.

We conclude that despite the great consensus that exists among all members of the health team on the importance of nontechnical skills for the surgical team in minimally invasive surgery, the reproducible evidence on the subject is scarce and laborious to obtain. To the extent that protecting and expanding nontechnical skills is fundamental to the path toward the high reliability of health institutions, it is possible to anticipate here the role of these institutions as promoters of continuity and new research models in this area of knowledge, especially in minimally invasive surgery, an access route to which more and more patients undergoing surgical treatment in these same institutions are submitted.

Keywords

nontechnical skills - minimally invasive surgery - surgical training


Publication History

Article published online:
29 March 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Vincent C, Neale G, Woloshynowych M. Adverse events in British hospitals: preliminary retrospective record review. BMJ 2001; 322 (7285): 517-519
    CrossrefPubMedGoogle Scholar
  • 2 Safer surgery: analysing behaviour in the operating theatre Rhona Flin Safer surgery: analysing behaviour in the operating theatre and Lucy Michell (Eds) Ashgate £75 482pp 9780754675365 9780754675365 [Formula: see text]. Nurs Manag (Harrow) 2010; 17 (08) 9
    PubMedGoogle Scholar
  • 3 Sexton JB, Thomas EJ, Helmreich RL. Error, stress, and teamwork in medicine and aviation: cross sectional surveys. BMJ 2000; 320 (7237): 745-749
    CrossrefPubMedGoogle Scholar
  • 4 Undre S, Sevdalis N, Healey AN, Darzi S, Vincent CA. Teamwork in the operating theatre: cohesion or confusion?. J Eval Clin Pract 2006; 12 (02) 182-189
    CrossrefPubMedGoogle Scholar
  • 5 Rosenstein AH, O'Daniel M. Impact and implications of disruptive behavior in the perioperative arena. J Am Coll Surg 2006; 203 (01) 96-105
    CrossrefPubMedGoogle Scholar
  • 6 de Vries EN, Prins HA, Crolla RMPH. et al; SURPASS Collaborative Group. Effect of a comprehensive surgical safety system on patient outcomes. N Engl J Med 2010; 363 (20) 1928-1937
    CrossrefPubMedGoogle Scholar
  • 7 Yule J, Hill K, Yule S. Development and evaluation of a patient-centred measurement tool for surgeons' non-technical skills. Br J Surg 2018; 105 (07) 876-884
    CrossrefPubMedGoogle Scholar
  • 8 Baldwin PJ, Paisley AM, Brown SP. Consultant surgeons' opinion of the skills required of basic surgical trainees. Br J Surg 1999; 86 (08) 1078-1082
    CrossrefPubMedGoogle Scholar
  • 9 Pucher PH, Brunt LM, Fanelli RD, Asbun HJ, Aggarwal R. SAGES expert Delphi consensus: critical factors for safe surgical practice in laparoscopic cholecystectomy. Surg Endosc 2015; 29 (11) 3074-3085
    CrossrefPubMedGoogle Scholar
  • 10 Yule S, Paterson-Brown S. Surgeons' non-technical skills. Surg Clin North Am 2012; 92 (01) 37-50
    CrossrefPubMedGoogle Scholar
  • 11 Gallagher AG, Ritter EM, Champion H. et al. Virtual reality simulation for the operating room: proficiency-based training as a paradigm shift in surgical skills training. Ann Surg 2005; 241 (02) 364-372
    CrossrefPubMedGoogle Scholar
  • 12 Palter VN, Grantcharov T, Harvey A, Macrae HM. Ex vivo technical skills training transfers to the operating room and enhances cognitive learning: a randomized controlled trial. Ann Surg 2011; 253 (05) 886-889
    CrossrefPubMedGoogle Scholar
  • 13 Fletcher GCL, McGeorge P, Flin RH, Glavin RJ, Maran NJ. The role of non-technical skills in anaesthesia: a review of current literature. Br J Anaesth 2002; 88 (03) 418-429
    CrossrefPubMedGoogle Scholar
  • 14 Yule S, Flin R, Paterson-Brown S, Maran N, Rowley D. Development of a rating system for surgeons' non-technical skills. Med Educ 2006; 40 (11) 1098-1104
    CrossrefPubMedGoogle Scholar
  • 15 Undre S, Sevdalis N, Healey AN, Darzi A, Vincent CA. Observational teamwork assessment for surgery (OTAS): refinement and application in urological surgery. World J Surg 2007; 31 (07) 1373-1381
    CrossrefPubMedGoogle Scholar
  • 16 Mishra A, Catchpole K, McCulloch P. The Oxford NOTECHS System: reliability and validity of a tool for measuring teamwork behaviour in the operating theatre. Qual Saf Health Care 2009; 18 (02) 104-108
    CrossrefPubMedGoogle Scholar
  • 17 Sevdalis N, Lyons M, Healey AN, Undre S, Darzi A, Vincent CA. Observational teamwork assessment for surgery: construct validation with expert versus novice raters. Ann Surg 2009; 249 (06) 1047-1051
    CrossrefPubMedGoogle Scholar
  • 18 Flin R, Youngson G, Yule S. How do surgeons make intraoperative decisions?. Qual Saf Health Care 2007; 16 (03) 235-239
    CrossrefPubMedGoogle Scholar
  • 19 Pauley K, Flin R, Azuara-Blanco A. Intra-operative decision making by ophthalmic surgeons. Br J Ophthalmol 2013; 97 (10) 1303-1307
    CrossrefPubMedGoogle Scholar
  • 20 Gawande AA, Zinner MJ, Studdert DM, Brennan TA. Analysis of errors reported by surgeons at three teaching hospitals. Surgery 2003; 133 (06) 614-621
    CrossrefPubMedGoogle Scholar
  • 21 Henrickson Parker S, Yule S, Flin R, McKinley A. Towards a model of surgeons' leadership in the operating room. BMJ Qual Saf 2011; 20 (07) 570-579
    CrossrefPubMedGoogle Scholar
  • 22 Catchpole KR, Giddings AEB, de Leval MR. et al. Identification of systems failures in successful paediatric cardiac surgery. Ergonomics 2006; 49 (5-6): 567-588
    CrossrefPubMedGoogle Scholar
  • 23 Leuschner S, Leuschner M, Kropf S, Niederbichler AD. Non-technical skills training in the operating theatre: a meta-analysis of patient outcomes. Surgeon 2019; 17 (04) 233-243
    CrossrefPubMedGoogle Scholar
  • 24 Catchpole K, Mishra A, Handa A, McCulloch P. Teamwork and error in the operating room: analysis of skills and roles. Ann Surg 2008; 247 (04) 699-706
    CrossrefPubMedGoogle Scholar
  • 25 Buljac-Samardzic M, Doekhie KD, van Wijngaarden JDH. Interventions to improve team effectiveness within health care: a systematic review of the past decade. Hum Resour Health 2020; 18 (01) 2
    CrossrefPubMedGoogle Scholar
  • 26 Paige JT, Kozmenko V, Yang T. et al. High-fidelity, simulation-based, interdisciplinary operating room team training at the point of care. Surgery 2009; 145 (02) 138-146
    CrossrefPubMedGoogle Scholar
  • 27 McCulloch P, Mishra A, Handa A, Dale T, Hirst G, Catchpole K. The effects of aviation-style non-technical skills training on technical performance and outcome in the operating theatre. Qual Saf Health Care 2009; 18 (02) 109-115
    CrossrefPubMedGoogle Scholar
  • 28 Tang B, Hanna GB, Joice P, Cuschieri A. Identification and categorization of technical errors by Observational Clinical Human Reliability Assessment (OCHRA) during laparoscopic cholecystectomy. Arch Surg 2004; 139 (11) 1215-1220
    CrossrefPubMedGoogle Scholar
  • 29 Catchpole KR, Giddings AEB, Wilkinson M, Hirst G, Dale T, de Leval MR. Improving patient safety by identifying latent failures in successful operations. Surgery 2007; 142 (01) 102-110
    CrossrefPubMedGoogle Scholar