Use of Human Reliability Analysis to evaluate surgical technique for rectal cancer

  • Peter John Wilson

    Student thesis: Doctoral ThesisDoctor of Philosophy


    Outcomes from surgery are dependent upon technical performance, as demonstrated by the variability that exists in outcomes achieved by different surgeons following surgery for rectal cancer. It is possible to improve such outcomes by focused training and the adoption of specific surgical techniques, such as the total mesorectal excision (TME) training programme in Stockholm which reduced local recurrence rates of cancer by 50%. It is generally accepted that good surgical technique is the enactment of a series of positive surgical actions, and the avoidance of errors. However, the constituents of good surgical technique for rectal cancer have not yet been studied in sufficient detail to identify the specific associations between individual steps and their consequences. In this study the ergonomic principles of human reliability analysis (HRA) were applied to video recordings of rectal cancer surgery. A system of error definition and identification was developed, utilising a bespoke software solution designed for the project. Calculation of optimal camera angles and position was determined in a virtual operating theatre. Analysis of synchronised footage from multiple camera views was performed, through which over 6,000 errors were identified across 14 procedural tasks. The sequences of events contributing to these errors are reported, and a series of error reduction mechanisms formulated for rectal cancer surgery.
    Date of Award2012
    Original languageEnglish
    SponsorsChief Scientist Office
    SupervisorBob Steele (Supervisor) & George Hanna (Supervisor)


    • Surgical technique
    • Rectal cancer
    • Human reliability analysis
    • Ergonomics
    • Human error
    • Task analysis

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