Current Approaches to Understanding Surgical Error: 2016

CAUSE: 2016 Keynote public address by Mr Henry Marsh


9th December 2016
9am Start, 6pm Finish


Clothworkers North Building LT G12, University of Leeds
West Yorkshire, UK

Conference registration is open. You can book your ticket now.


On the science of safer surgery

The Perception-Action-Cognition Laboratory at the University of Leeds are pleased to host the CAUSE symposium in December 2016. This is RCSEd sponsored event that draws together leading researchers from a variety of disciplines (cognitive psychology, neuroscience, computer science, engineering) who share an interest in understanding the aetiology of surgical error.

Signing Up

Registration is now open. You can book your ticket directly through the University of Leeds Online Store. Click here. Early bird rates last until 30th September.

Peer-reviewed Poster Presentations

If you would like to showcase your work at our Data Blitz (3 minute presentation) submit a 300 word abstract. *** Submission is now closed. ***

Early Career Awards

The best data blitz talks, as voted for by delegates, will be receive vouchers for reduced open access fees for full paper submissions to the Journal of Surgical Simulation.

The Speakers

Details on our invited speakers. Public keynote address by Henry Marsh.


Consultant Psychiatrist

Author of Smart Surgeons: Shapr Decisions. Expert in applying psychological literature of decision-making to surgical practice.


Clinical Lecturer

Expertise in virtual reality simulation and Restorative Dentistry.


Associate Professor in Surgical Technology

Develops new technologies for minimally invasive surgery, with a focus on oncology applications.


Academic Clinical Fellow

Academic researcher developing physical and mental preparation techniques for Colorectal surgery


Professor of Neuropsychology

Consultant Neuropsychologist and author of "On the pursuit of clinical excellence."



Completing MD in surgical training and performance.


Emeritus Consultant Nurse

Programme leader for MSc Medical and Healthcare Simulation course.

Symposium Schedule

A line-up of leading academics and clinicians.


Registration & Breakfast

09:00 - 09:10

Welcoming Address by Professor Mon-Williams

09:15 - 09:55

Cognitive simulation-expertise without experimentation

Uttam Shiralkar
Psychological Medicine

Dr Shiralkar is author of best-selling books: Surgeon, Heal Thyself and Smart Surgeons Sharp Decisions: Cognitive Skills to Avoid Errors & Achieve Results. In this presentation, Dr Shiralkar explains that Psychology IS for surgeons!

10:00 - 10:45

Can cognitive psychology help us understand surgical safety issues?

Narinder Kapur
Cognitive Psychologist

While human factors approaches to surgical error are well-established, there has been relatively less attention as to how the field of cognitive psychology can help us understand surgical safety issues. I firstly provide an overview of cognitive considerations, ranging from memory and attention lapses to unconscious bias. I consider similarities and differences between aviation and healthcare, and I take two prototypical examples from each and consider them from a cognitive psychology perspective. Taking a set of clinical Never Events, I consider a possible framework for understanding cognitive factors that may contribute to adverse surgical events, and how an ‘affordance’ framework may help in highlighting remedial approaches. I provide preliminary data on a retrospective analysis of adverse events reported to the Royal College of Surgeons Confidential Reporting Systems in Surgery committee (CORESS), using the conceptual framework drawn up by Lawton et al. (BMJ Qual Saf, 2012). Drawing on some of our initial findings, I consider possible remedial interventions, such as perceptual training for perceptual identification errors.

10:45 - 11:15

Tea & Coffee Break

11:20 - 12:00

Pre-operative mental practice for the prevention of surgical error

Marina Yiasimidou
Academic Clinical Fellow

Despite preventive measures such as safety checklists, “time-outs” with the entire theatre team and marking the correct side for surgery, more than four thousand preventable surgical errors occur every year. Lack of attention to detail, the hierarchical culture within the National Health System, stress and fatigue, increasing pressures to start and finish surgical procedures and even unusual anatomical characteristics, have been identified as potential reasons for adverse surgical events. However, the underlying cognitive mechanisms which lead to surgical error are not fully understood. Could cognitive preparation prior to surgery be the key to preventing surgical error? Mental practice has been assessed in simulated surgical environments. Some of the outcome measures included surgical errors. Nevertheless, a simulated environment is considered by many as a relatively “stress free environment”, hence eliminating one of the factors that may precipitate surgical error. Assessment of the technique in a clinical (surgical) environment through high quality studies is urgently needed. Further, patient characteristics are linked with increased technical difficulty and surgical error, however, mental practice is a generic method which remains the same for each type of surgery. Also its success is reliant to the individual ability to perform mental imagery, which may vary form surgeon to surgeon. These are factors that should be taken under consideration in future research. Another factor that should be evaluated is the experience of the surgeon. Studies showed that more experienced individuals perform cognitive preparation in a more effective manner. Is mental practice relevant for consultants or is it a method that should be employed by trainee surgeons only. Studies to-date have not explored the potential impact of mental practice in expert performance. Current research undertaken in our department aims to answer these questions and prove or dismiss the impact of mental practice in preventing surgical error and overall improving surgical performance.

12:10 - 12:30

“Data Blitz“ Session

Early Career Researchers Short Presentations

12:30 - 13:30

Lunch Break

13:30 - 14:00

Warming up and surgical outcomes

Tom Pike

Further details coming soon.

14:00 - 14:45

Developing and Implementing Haptic Surgical Rehearsal in Dentistry

Andrew Keeling
Lecturer in Dental Education

The five year dental undergraduate course is designed to prepare students to become independent dental practitioners at the level of ‘safe beginner’. A combination of simulated clinical training and actual clinical practice on real patients forms the bedrock of the undergraduate programme. The clinical practice component is variable, depending on patient needs, so there is a reliance on maximising the learning experience from each clinical event. Ensuring patient safety is also paramount. One aspect of dentistry which requires high precision, and specific tailoring to the patient, is the preparation of dental crowns. This procedure involves shaping a tooth to very specific dimensions, then taking an impression of the prepared tooth in order to manufacture the new crown. Training students to perform dental crown preparations typically involves practising on plastic teeth. Whilst this helps the student learn the manual skills required, the actual shape of the preparation will always be heavily influenced by the specific arrangement of the patients’ teeth. The plastic teeth tend to be ‘ideal’ in shape – patients’ teeth are rarely so. This can lead to over-preparation of (and unnecessary damage to) a patients’ tooth, because the student is not experienced in adapting ideal crown preparations to the specific patient anatomy. To help a student better prepare for a real clinical crown preparation, we have developed a method for uploading the real patient onto a 3D virtual reality haptic dental trainer (Simodont, MOOG Nieuw-Vennep). This simulator gives the user the feeling that they are drilling teeth, and has a facsimile of a dental handpiece as the haptic ‘mouse’, making the users grip feel natural and realistic. The simulator allows the student unlimited practice attempts in a safe environment before the day of the real clinical procedure. A 3D interactive view of the preparation can be emailed to the clinical tutor for comment and feedback. Informal feedback on the system has been positive from both students and staff alike. More formally, we are collecting written feedback to identify the best methods of implementation within the curriculum. Patient-specific haptic simulation offers dental students a safe environment in which to rehearse real clinical procedures.

14:45 - 15:00

Afternoon Tea

15:00 - 15:50

Authenticity, Stress & Debriefing - Learning through simulation

Ken Spearpoint
Emeritus Consultant Nurse

Details coming soon.

15:50 - 16:30

Grasping Improvements in Laparoscopic Surgery

Peter Culmer
Associate Professor in Surgical Technologies

Tissue trauma as a result of surgical manipulation occurs routinely during laparoscopic surgery with potentially severe consequences. The use of surgical graspers (forceps) on delicate tissues like the bowel can lead to an intestinal inflammatory response that contributes to post-operative ileus, increases the risk of complications and delays discharge. A major causative factor is believed to be limitations in the instrumentation, most notably a lack of haptic feedback which results in excessive pressures being applied to tissues by the grasper jaws. Our research has sought to develop a mechanistic understanding of how instrument-induced tissue trauma occurs in laparoscopic surgery, ultimately to inform improvements in patient safety. We firstly sought to understand how laparoscopic graspers are used in a surgical context, using digitally-instrumented graspers in simulated surgical procedures with a cohort of surgeons at different training levels. Our results show the pressure characteristics applied to soft tissues have a wide variability across and within training levels, indicating that regulation of force is both difficult to achieve, and not a primary goal, while grasping. Secondly, we investigated the mechanics of grasper-induced trauma using parametric lab studies, an ex vivo tissue model and histological analyses. We found that trauma occurred as a function of both pressure magnitude, rate and exposure time. Furthermore, we observed that the onset of trauma can be predicted through readily available measures of the tissue’s mechanical response during grasping. The outcomes of this research have significance for both surgical training (improving understanding of the risks of mechanical-tissue trauma and mitigation strategies) and improved instrumentation (e.g. grasper systems with feedback and control). These approaches can help to reduce unnecessary tissue trauma and associated complications to enhance the benefits of laparoscopic surgery and improve patient safety.

17:00 - 18:00

Better not look down

Mr Henry Marsh
Public Keynote Address

Abstract: Two years ago, with retirement approaching, I thought I should look back on my career – almost four decades of neurosurgery – and reflect on what I had learned. This meant, of course, thinking about the many mistakes I had made over the years, since we learn little from success. So every night I took a notebook and pencil to bed with me and when I woke in the morning I would lie in bed and, drifting in and out of lucid dreaming, try to remember my mistakes. The ghosts of the patients who had suffered at my hands would drift up into my consciousness, like methane stirred up from a stagnant pond, long-forgotten and deeply painful to remember. It was an unpleasant process, and I soon discovered that if I did not write them down immediately I would quickly forget them all over again.

The Keynote lecture delivered by Henry Marsh is free to attend but online registration is required in advance through Eventbrite. Click here to reserve a place.

On Surgery:

When push comes to shove we can afford to lose an arm or a leg, but I am operating on peoples thoughts and feelings... and if something goes wrong I can destroy that persons character... forever Henry Marsh

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Early career Registration Fee

Reduced rate for undergraduate and postgraduate students without external research funding. Click here.


NHS Staff Registration Fee

The registration fee includes the following breakfast (tea coffee and pastries, orange juice), lunch (sandwich platter) and afternoon coffee/tea. Click here.


Early Career Early Bird Registration Fee

For a limited time only we have reduced rates for early career academics and clinicians. Click here.

Sponsors & Partners

This event would not be possible without the support of the following:

University of Leeds Campus

Leeds, West Yorkshire, LS2 9JT

Spend an inspiring day in the cosmpolitan city of Leeds.


Clothworkers North Building, Lecture Theatre G12

University of Leeds, Leeds

West Yorkshire, LS2 9JT

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University of Leeds Campus

All talks will be held at the Campus. A map of the local area together with directions can be viewed here.

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Accomodation details

The University of Leeds has year-round accommodation which is available to guests from just £44 per room per night, perfect for a short stay at the University or visiting the City of Leeds. The stylish bedrooms feature floor-to-ceiling windows, data access, room safes, and free internet access. It is one of the University’s best residences and has been accredited with a 4-star grading from Visit England. The accommodation can be booked through this link.

Leeds is a bustling city, surrounded by beautiful countryside. A thriving cultural centre, it is also home to some of the country’s major sports venues. It’s a diverse city with a huge range of places to eat and drink. The symposium takes place on our single-site campus, one of the largest in the UK and is just a short walk from the centre of Leeds. Everything is in one place and it's really easy to get around.

Getting here

The University of Leeds is committed to reduce its carbon dioxide emissions caused by both commuting and business travel. We encourage visitors to use public transport, bicycles and their feet as often as possible. To plan your journey to the University we recommend using Traveline which you can use to plan your journey by public transport. You can find more details on how to get to us via this link.

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