Table 1.
Summarized matrix of the most representative phases for the process “laparoscopic sigmoidectomy” for each of which a RPN has been calculated as follows: RPN = SE * PO * PD
| Phase | Possible failure | Reason of failure | Direct effect of failure | Indirect effect of failure | SE | PO | PD | RPN |
|---|---|---|---|---|---|---|---|---|
| 1. Fixation of patient to the operation table | Failure to fix patient correctly | Ignoring the preparation step | Fall of patient from the operation table | Lesions caused by fall | 7 | 5 | 9 | 315 |
| Problems in obtaining surgical field | Conversion to open surgery | 8 | 5 | 1 | 40 | |||
| Peripheral nerve entrapment syndromes | Functional impairment | 7 | 5 | 9 | 315 | |||
| 2. Trocars placement | Bleeding from the trocar site | Technical | Hemodynamic impairment | Transfusion | 4 | 8 | 2 | 64 |
| Longer time to start surgery | Longer anaesthesia time | 4 | 8 | 2 | 64 | |||
| Postoperative bleeding | Reoperation | 8 | 8 | 6 | 384 | |||
| Wrong trocar placement | Technical | Longer surgery time | Longer anaesthesia time | 4 | 8 | 2 | 64 | |
| Erroneous tumour localization | Longer anaesthesia time | Longer anaesthesia time | 4 | 8 | 2 | 64 | ||
| Conversion to open surgery | Longer anaesthesia time | 7 | 8 | 1 | 56 | |||
| Rise in SSI | 8 | 8 | 1 | 64 | ||||
| Trocar site non-suitable for ileostomy | Technical | Infection of trocar site for ileostomy | Rise in SSI | 8 | 8 | 1 | 64 | |
| 3. Localisation and division of the arterial pedicle | Separate division of haemorrhoidal and sigmoidal arteries | Technical | Low number of lymph nodes | Oncological failure | 8 | 8 | 9 | 576 |
| Bleeding | Technical | Conversion to open surgery | Rise in SSI | 7 | 8 | 1 | 56 | |
| Confounding haemorrhoidal artery with ureter | Technical | Longer surgery time | Longer anaesthesia time | 7 | 8 | 1 | 56 | |
| Ureter lesion | Functional impairment | 8 | 8 | 6 | 384 | |||
| 4. Localization and dissection of the ureter | Inadvertent division of the ureter | Technical | Tutorization of the ureter | Longer anaesthesia time | 7 | 8 | 1 | 56 |
| Confounding haemorrhoidal artery with ureter | Urethral stenosis | Functional impairment | 8 | 8 | 6 | 384 | ||
| Confounding with gonadal vessels | Conversion to open surgery | Rise in SSI | 7 | 8 | 1 | 56 | ||
| 5. Division of the surgical specimen | Intestinal wall perforation | Technical | Conversion to open surgery | Oncological failure | 8 | 7 | 1 | 56 |
| Various sections of the specimen (many stapler loads) | Wrong trocar placement | Anastomotic dehiscence | Functional impairment | 8 | 7 | 7 | 392 | |
| Narrow pelvis | Anastomotic dehiscence | Functional impairment | 8 | 7 | 7 | 392 | ||
| Small cutting linear stapler load | Anastomotic dehiscence | Functional impairment | 8 | 7 | 7 | 392 | ||
| 6. Mechanical anastomosis | Twist of the proximal end | Technical | Anastomotic dehiscence | Functional impairment | 8 | 3 | 8 | 192 |
| Impossibility to introduce circular stapler | Narrow pelvis | Longer surgery time | Longer anaesthesia time | 7 | 8 | 1 | 56 |
RPN values range = 1–1000
SE severity of event, PO probability of occurence, PD probability of detection, RPN risk priority number, SSI surgical site infections