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Minerva Ginecologica 2019 August;71(4):272-80

DOI: 10.23736/S0026-4784.19.04227-8


lingua: Inglese

Application of failure mode and effect analysis in total laparoscopic hysterectomy in benign conditions

Davide LIJOI 1 , Massimo FARINA 2, Andrea PUPPO 3, Antonia NOVELLI 3, 4, Simone FERRERO 5

1 Unit of Obstetrics and Gynecology, Galliera Hospital, Genoa, Italy; 2 Department of Management and Training, EmmEffe s.r.l., Milan, Italy; 3 Unit of Obstetrics and Gynecology, Regina Montis Regalis Hospital, Mondovì, Cuneo, Italy; 4 Division of Gynecologic Oncology, Department of Women and Child Health, Sacred Heart Catholic University, Rome, Italy; 5 Unit of Obstetrics and Gynecology, San Martino Polyclinic Hospital and Institute for Research and Care, University of Genoa, Genoa, Italy

BACKGROUND: Hysterectomy is the most common major gynecological operation in developed countries. The rate of intraoperative complications related to the laparoscopic approach during hysterectomy is a relevant issue. The failure mode and effect analysis (FMEA) method is a prospective approach, which tries to identify possible errors before they occur.
METHODS: In this study we applied the FMEA method to laparoscopic approach to hysterectomy in order to reduce the theorized risk of intraoperative complications. We selected a team who analyzed and deconstructed the total laparoscopic hysterectomy (TLH) process recording on the FMEA worksheet phases and activities of the entire procedure. Each activity-related failure mode and their potential effects were developed. The team also described actions to eliminate or decrease the likelihood of mistakes.
RESULTS: A numerical value reflecting the risk was assigned to each activity. Five activities were identified as high priority risk, and for each activity actions were then taken to mitigate the identified risk. After introduction of these actions, the risk scores for each activity were recalculated, and we obtained a total risk reduction of 55%.
CONCLUSIONS: It is our opinion that the systematic implementation of the FMEA model can reduce the risk of human error during laparoscopic surgery, improving patient safety.

KEY WORDS: Laparoscopy; Hysterectomy; Risk management; Gynecologic surgical procedures

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