ANNAPURNA PANDRAVADA SPECIALITY TRAINEE 7

 Procedure documentation is crucial in every speciality, so is in laparoscopic surgery.  It ensures consistency and continuity and an indicator of quality of care.  Systematic documentation of surgical procedures is important for research and medico legal purposes.

 About 250,000 women undergo laparoscopic surgery in UK each year.  Merits of the laparoscopic surgery over open surgery are well known.  The majority are without problems but serious complications occur in about one in 1000 cases.  Majority of them occur during entry into the abdomen.

 Various entry techniques  Different equipment  Electro surgery principles  Ergonomics  Various retrieval techniques

 Abdominal hysterectomy done.  Routine entry and procedure routine  Procedure: right thoracotomy: upper lobotomy, medistinal lymphadenecotomy Description of procedure: A mass was found in the upper lobe of the right lung. The patient tolerated the procedure well, and was taken to the recovery room in stable condition."

 To explore the clinicians way of documentation in laparoscopic surgery.  To find out the views about the uniform documentation and nation wide database.

 Questionnaire consisting of 10 questions was sent out to the gynaecologists (consultants and trainees) in Scotland, and also to some senior trainees and consultants in England.  Over a period of 3 wks  Overall 108 responses received

 What stage are you?

 No of laparoscopies performed per month

 Do you have special interest in minimal access surgery?

 Do you have in your department a special or separate documentation sheet for laparoscopy  If so do you use it?

 Do you document in the notes (please tick all those apply) Entry technique used93.8% Primary port site and size93.8% Secondary port site and size 92.7% Pressure on entry46.9% Intra operative pressure34.4% Closure of the port sites99% Local anaesthetic89.6%

 How do you document findings in operative laparoscopy?(please tick all those that apply) Written notes92.8% Image documentation75.3% Schematic drawings43.3% Videotape and other electronic storage medium 13.4%

 How do you document findings of endometriosis at operative laparoscopy?(Please tick all those apply) Revised AFS classification34% Any other classification2.2% Written notes and image documentation 80%

 Do you feel a uniform documentation is useful for operative laparoscopy?  Do you feel that nationwide data base is necessary?

Comments  Too many forms, special forms available in endometriosis centres.  Uniform documentation helpful  Averse to pre printed forms  Huge disparity between clinicians and nothing much will change until there is useful national data that can exert peer pressure.  I take pictures when possible  A universal standard of equipment might be a worthwhile option.

 This survey shows us that there is good documentation in many aspects.  There is increasing usage of image documentation.  Most of them also felt that uniform documentation and nationwide data base are essential.  Improvement needed in documenting the intra abdominal pressures during entry and also during insertion of secondary ports

 Adequate and thorough documentation should include the counselling of the patients about the procedure, operative notes and complications. This is not replaceable by any other electronic media.  Uniform documentation prompts the clinician to take a systematic approach, avoids human errors.  Data quality is crucial for statistical evaluation, which in turn help to set up a nationwide database.  In conclusion, this will improve the patient care, decrease the litigation and satisfaction of the clinician.

 I will add

 Dr. Santanu Acharya and Dr David Rae  Survey monkey  All the responders

THANK YOU