Improving Health Care Quality and Safety: The Development and Assessment of Laparoscopic Surgery Instrumentation, Practices and Procedures

Adverse events due to medical errors are a leading cause of death in the United States exceeding the mortality rates of motor vehicle accidents, breast cancer and AIDS. Improvements can and should be made to reduce the rates of preventable surgical errors since they account for nearly half of all adverse events within hospitals. Although minimally invasive surgery has proven patient benefits such as reduced postoperative pain and hospital stay, its operative environment imposes substantial physical and cognitive strain on the surgeon increasing the risk of error. In order to mitigate errors and protect patients, a multidisciplinary approach was taken to improve minimally invasive surgery. Clinical, human factors, and biomedical engineering principles and methodologies were used to develop and assess laparoscopic surgery instrumentation, practices and procedures. First, the foundational understanding and the imperative to transform health care into a high quality and safe system is discussed. Next, a generalized perspective is presented on the impact of the design and redesign of surgical technologies and processes on human performance. The remainder of this dissertation presents the experimental results of four studies used to develop and assess laparoscopic surgery instrumentation, practices and procedures. In the first experiment, a novel hand-controlled electrosurgical laparoscopic grasper was developed and evaluated to eliminate the use of foot pedals, reduce surgery-related discomfort, and minimize the risk of actuation errors. The final three studies compared the emerging technique of single-incision surgery to conventional laparoscopic surgery to determine whether there were any technical, physical or subjective performance differences across the two surgical techniques. In all, these studies contribute towards the improvement of the quality and safety of minimally invasive surgery. Advisor: M. Susan Hallbec