In recent years a flow of media reports about unsafe situations in operating rooms have reached the general public. Awareness of the importance of patient safety also reached politicians. The... Show moreIn recent years a flow of media reports about unsafe situations in operating rooms have reached the general public. Awareness of the importance of patient safety also reached politicians. The report by the Dutch inspectorate of health care __Risico__s minimaal invasieve chirurgie onderschat__ (Risks minimally invasive surgery underestimated) stressed that patient safety is especially at risk in Minimally Invasive Surgery. Therefore patient safety became a focus of research and quality improvement, also in minimally invasive surgery. The current thesis aimes to give insight into patient safety risk factors in minimally invasive surgery. Of all examined risk factors minimally invasive surgical skills appeared to be directly related to patient safety. Therefore special focus for training of these skills is necessary. Previous research has shown that during simulation training objective assessment of economy of movements and time is possible. However, until recently there was no way to objectively assess one of the most important surgical skills: tissue handling. The development of a force sensor has made it possible to measure interaction forces with artificial tissue. In this thesis the clinical implications of a force sensor and the need of this new technology within training of minimally invasive surgical skills is examined. Show less
The development of gynecological laparoscopy in The Netherlands is slow. Laparoscopic training needs more emphasis during residency training. The laparoscopic simulator needs to be officially... Show moreThe development of gynecological laparoscopy in The Netherlands is slow. Laparoscopic training needs more emphasis during residency training. The laparoscopic simulator needs to be officially implemented into residency curriculum guidelines and incorporated into practice. Simulator training should be structured and mandatory, as a training tool, as well as a skills assessment tool. In order for residents to obtain a sufficient and uniform level of skills, their surgical skills need to be measured individually and objectively by means of the simulator. In addition, experts' level on the simulator can be set as performance standards for residents and should be reached by residents before performing live laparoscopic surgery. Assisting during laparoscopic hysterectomy should be added to the requirements for graduation in the curriculum guidelines. To accomplish these recommendations, skilled laparoscopic gynecologists are required in every teaching hospital. Besides the beneficial aspects for residency training, a skilled laparoscopic gynecologist is needed to establish an internal referral system for procedures such as laparoscopic hysterectomy. For the other advanced laparoscopic procedures a regional or national referral system can be created. Show less
