Long-term effects of perioperative briefing and debriefing on team climate: A mixed-method evaluation study.

INTRODUCTION: To evaluate the long-term (5 years) effects of perioperative briefing and debriefing on team climate. We explored the barriers and facilitators of the performance of perioperative briefing and debriefing to explain its effects on team climate and to make recommendations for further improvement of surgical safety tools. METHODS: A mixed-method evaluation study was carried out amongst surgical staff at a tertiary care university hospital with 593-bed capacity in the Netherlands. Thirteen surgical teams were included. Team climate inventory and a standardised evaluation questionnaire were used to measure team climate (primary outcome) and experiences with perioperative briefing and debriefing (secondary outcome), respectively. Thirteen surgical team members participated in a semi-structured interview to explore barriers and facilitators of the performance of perioperative briefing and debriefing. RESULTS: The dimension "participative safety" increased significantly 5 years after the implementation of perioperative briefing and debriefing (P = .02 (95% confidence interval 1.18-9.25)). Perioperative briefing and debriefing were considered a useful method for improving and sustaining participative safety and cooperation within surgical teams. The positive aspects of briefing were that shared agreements made at the start of the day and that briefing enabled participants to work as a team. Participants were less satisfied regarding debriefing, mostly because of the lack of a sense of urgency and a lack of a safe culture for feedback. Briefing and debriefing had less influence on efficiency. CONCLUSIONS: Although perioperative briefing and debriefing improve participative safety, the intervention will become more effective for maintaining team climate when teams are complete, irrelevant questions are substituted by customised ones and when there is a safer culture for feedback.

Design of a box trainer for objective assessment of technical skills in single-port surgery.

OBJECTIVE: Laparoscopic single-port (SP) surgery uses only a single entry point for all instruments. The approach of SP has been applied in multiple laparoscopic disciplines owing to its improved cosmetic result. However, in SP surgery, instrument movements are further restricted, resulting in increased instrument collisions compared with standard multiport (MP) laparoscopy. METHODS: Our goal was to develop a trainer that can quantitatively measure task time, force and motion data during both MP and SP training to investigate the influence of instrument configuration on performance. Custom-made abdominal force sensors and accelerometers were integrated into a new training box that can be used in an SP and an MP configuration. This new box trainer measures forces, acceleration, and tilt angles during training of SP and MP laparoscopy. With the new trainer, 13 novices performed a tissue manipulation task to test whether significant differences exist between MP and SP in maximum abdominal force, maximum tissue manipulation force, maximum acceleration, and tilt angles of the handles. RESULTS: The results show that the task time (SP-145s, standard deviation (SD) = 103 vs MP-61s SD = 16), maximum abdominal force (SP-8.4N, SD = 2.0 vs MP-left (L)-3.3N, SD = 0.8 and MP-right (R)-5.8N, SD = 2.1), tissue manipulation force (SP-10.4N, SD = 3.6 and MP-5.6N, SD = 1.3), maximum acceleration (MP-L-9m/s(2), SD = 5 vs SP-L-14m/s(2), SD = 7), and tilt angles of the left handle are significantly higher in SP. CONCLUSIONS AND DISCUSSION: This study shows that the new trainer can be used to find the most important differences in instrument and tissue handling, which is an important step toward the assessment of surgical skills needed for safe SP surgery depending on force and motion-based parameters.

Psychophysiological assessment of sexual function in women after radiotherapy and total mesorectal excision for rectal cancer: a pilot study on four patients.

INTRODUCTION: The potential contribution of psychological and anatomical changes to sexual dysfunction in female patients following short-term preoperative radiotherapy (5 x 5 Gy) and total mesorectal excision (TME) is not clear. Aim. In this study we assessed female sexual dysfunction in patients who underwent radiotherapy and TME for rectal cancer. MAIN OUTCOME MEASURES: Genital arousal was assessed using vaginal videoplethysmography. METHODS: Sexual functioning was examined in four patients who had rectal cancer and underwent radiotherapy and TME. All investigations were done at least 15 months after treatment. The results were compared with an age-matched group of 18 healthy women. RESULTS: The patients and healthy controls showed comparable changes in vaginal vasocongestion during sexual arousal, though three out of four patients showed a lower mean spectral tension (MST) of the vaginal pulse compared with healthy controls. Subjective sexual arousal was equivalent between the two groups. CONCLUSIONS: In this study the changes of genital and subjective sexual arousal after erotic stimulus condition between patients and healthy controls were not different, though lower MST of the vaginal pulse was found in three out of four patients compared with healthy women. Additional work, however, must be performed to clarify the mechanisms of sexual dysfunction following treatment of rectal cancer.