Table 2

Themes of patient and hospital manager perceptions with illustrative quotes

ThemesPatient
Categories
QuotesHospital managers
Categories Quotes
Positive expectations of LS Perceptions of benefits for patients, hospital and social Laparoscopic surgery is far better, I would choose that anytime’. (P1) Perception of benefits for patients, hospital and social I would say absolutely yes it benefits the patients; if I was a patient that is what I would want’. (M6.2)
Perceived fewer complications ‘The risks and complications must be less than open surgery’. (P16) Perceived fewer complications You are going to have fewer complications and don’t have scars across the abdomen’. (M11.5)
Potential reduced length of stay‘If we reduce length of stay, we can close beds and it stacks up as business case’. (M2.13)
LS as the future of surgery‘It is efficient and what consultants want to do these days’. (M6.6)
Perceptions of problems and financial implications of LS No disadvantages of LS I have not heard of any disadvantages of keyhole surgery’. (P25) No disadvantages of LS “‘I do not think there are any down sides’. (M6.9)
Conversion to laparotomy ‘My main concern is if something goes wrong, how quickly they can open you up’. (P17) Conversion to laparotomy ‘I suppose one of the down sides is if it has to go to an open procedure’. (M6 .7)
Cost/benefit analysis ‘Even though the equipment may be more expensive, people are in hospital for a shorter time so you are saving on hospital beds’. (P1)Need for a skilled surgeon‘Some people are slow and that is bad from a cost perspective’. (M2.52)
Difficulty in training for LS ‘I imagine LS is harder to practice for junior trainees than open surgery’. (P6)Appropriate patients‘I think it should not be seen as the panacea for everything and every patient’. (M2.10)
Lack of examination‘My fear is that as you have not been opened up, they can’t have a proper look around’. (P9) Cost / benefit analysis ‘I do not think there has been a business case written looking at the advantages and disadvantages as oppose to the income and costs; I reserve judgement until I see that’. (M1.15)
Cost‘It is phenomenal the amount of money we spend on it’. (M2.53)
Increased theatre time‘Procedures generally take longer in theatre than open procedures’. (M1.22)
Patient expectations‘You have to get patients expectations right; it can sound like a minor procedure if you do it keyhole whereas actually it can have its own set of complications’. (M3.11)
Difficulty in training for LS ‘I imagine LS is harder to practice for junior trainees than open surgery’. (M9.6)
Lack of awareness of difficulties with surgical training Lack of knowledge of how surgeons are trained ‘You just assume a surgeon will be competent when you go down for surgery, it is not something you really think about’. (P2) Lack of knowledge of how surgeons are trained ‘It probably does not even cross our minds to be honest how junior doctors are trained’. (M6.18)
External pressures affecting training The tolerance to a training list has changed massively, there is so much scrutiny and pressure on theatre utilisation and profitability’. (M5.23)
Effect of training on patient safety‘Safety can be compromised when people are learning. With any surgeon doing an operation for the first time, be it open or laparoscopic, the patient is at greater risk’. (M4.16)
Effect on theatre lists From a service perspective we need well trained middle grade registrars so that when the consultant is away they can do the list’. (M2.34)
Training and theatre efficiency‘Training unfortunately always decreases theatre utilisation’. (M1.30)
Desire for laparoscopic simulation training and competency testing for patient benefit Improve training ‘If you can have a go at it on the simulator you will be better when it comes to the real life operation’. (P1) Improve training ‘If a simulator helps them move more quickly through their training so they are competent to operate on patients in the absence of their consultant that would be good’. (M2.36)
Patient safety ‘It’s better to destroy a computer rather than a person’. (P1) Patient safety ‘I think it is a good idea, particularly if it gives people confidence and allows people to make mistakes and learn from them in a way that does not cause harm’. (M5.51)
Competency testing ‘You would feel more confident in your surgeon if you knew they had passed a competency on a simulator first’. (P20) Competency testing ‘I think a simulated competency test sounds like a very good idea and I think if I was a patient I would think that it is a very good idea’. (M5.49)
Simulation in other professions‘I would be happy for a pilot who had completed a simulated competency to fly my plane, it should be the same with surgery’. (P22)
Conflicting priorities of laparoscopic simulation in healthcare Possible financial benefit of simulation ‘It is going to save the NHS a lot of money in the long run if you make operating safer’. (P1) Possible financial benefit of simulation ‘We should be spending money on simulators because it financially makes sense’. (M7.55)
NHS needs to invest in future ‘They need to look at long term outcome and long term savings; it is obviously going to be saving money in the future’. (P25) NHS needs to invest in future ‘It is a good idea and I think we are really slow at using technology in the NHS to our advantage’. (M4.32)
Possible reduction in litigation ‘If something goes wrong when a junior doctor is operating, surely the costs are greater in the long run through litigation’. (P16) Possible reduction in litigation ‘It might pay for itself tenfold if it stops a multi-billion pound negligence claim’. (M11.19)
Trust wide approach to purchasing simulators In our difficult financial environment you would want directorates to club together and put in a case’. (M3.30)
Drawbacks of surgical simulation trainingLack of realism‘You may come across a scenario in theatre that you can not reproduce on the simulator’. (P15)
‘Not sure it would give the same sensation as real operating’. (P17)
Proving financial benefits‘The impact of laparoscopic simulators is not seen as well as compared to other equipment’. (M1.43)
Need for mandatory simulation training‘If we are going to invest in it, we need to make sure people are using it’. (M1.65)
  • *Overlapping categories of patient and manager perceptions in bold.

  • LS, laparoscopic surgery; NHS, National Health Service.