Hidden Challenges in Laparoscopic Instrument Maintenance: A Qualitative Exploration of Training and Safety Concerns.

BACKGROUND: Over the past two decades, the rapid expansion of laparoscopic procedures has substantially increased dependence on sophisticated surgical instruments, camera systems, insufflators, energy devices such as monopolar and bipolar electrocautery, advanced bipolar and ultrasonic devices, and advanced sterilization technologies. Consequently, the success of laparoscopic surgery depends not only on surgical expertise but also on the effective functioning, maintenance, reprocessing, and handling of specialized equipment by the operating theater (OT) team.

AIM: The study aimed to qualitatively explore the experiences, operational difficulties, safety concerns, and training needs related to laparoscopic instrument maintenance among OT technicians, nursing officers, and residents in the Department of Obstetrics and Gynecology of a tertiary care teaching hospital.

MATERIALS AND METHODS: A descriptive qualitative study was conducted in the Department of Obstetrics and Gynecology at the tertiary care teaching hospital. The study participants included residents, nursing officers, and OT technicians who were directly involved in laparoscopic surgeries and perioperative instrument management. A quota-based purposive sampling technique was used to ensure adequate representation, and a total of 30 participants were included, comprising 10 residents, 10 nursing officers, and 10 OT technicians. Focus group discussions (FGDs) were selected as the data collection method. The study was conducted and reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Data were collected using a semi-structured interview and continued until thematic saturation was achieved.

RESULTS: Thematic analysis of the FGDs identified six major themes related to laparoscopic instrument maintenance and handling practices: training deficiencies, equipment-related challenges, sterilization and reprocessing issues, instrument-handling difficulties, safety concerns, and workflow and communication barriers. OT technicians predominantly discussed technical and maintenance-related concerns, including damage to delicate cables, preventive servicing requirements, and sterilization limitations. Nursing officers mainly emphasized workflow coordination, patient safety concerns, and the need for standardized checklists. Residents primarily highlighted deficiencies in troubleshooting skills and formal laparoscopic training.

CONCLUSIONS: The present study highlights that laparoscopic instrument maintenance is an important yet often underrecognized component of minimally invasive surgical safety.