Error rating tool to identify and analyse technical errors and events in laparoscopic surgery

Br J Surg. 2013 Jul;100(8):1080-8. doi: 10.1002/bjs.9168.


Background: Surgical error analysis is essential for investigating mechanisms of errors, events and adverse outcomes. Furthermore, it provides valuable information for formative feedback and quality control. The aim of the present study was to design and validate a technical error rating tool in laparoscopic surgery.

Methods: The framework consisted of nine task groups and four error modes. Unedited videos of laparoscopic Roux-en-Y gastric bypass procedures were rated and analysed. The Objective Structured Assessment of Technical Skill (OSATS) global rating scale was used to assess technical skills. The incidence of errors and of injuries (events) were the main outcome measures, and were used to calculate the reliability, and construct and concurrent validity of the instrument.

Results: Two observers analysed 25 procedures. Inter-rater reliability was high regarding total number of errors (intraclass correlation coefficient (ICC) 0·90) and events (ICC 0·85). The median (interquartile range) error rate was 35 (26-44) and the event rate 3 (2-3) per procedure. Error frequencies and OSATS scores correlated significantly in all operative steps (rs = -0·75 to -0·40, P = <0·001-0·046). Surgeons demonstrating high OSATS scores had lower median (i.q.r.) error rates than surgeons with low scores in three of four steps: measuring bowel (4 (2-7) versus 10 (9-11); P = 0·004), jejunojejunostomy formation (5 (2-6) versus 10 (9-11); P = 0·001) and pouch formation (4 (3-6) versus 9 (5-12); P = 0·004).

Conclusion: The proposed error rating tool allows an objective and reliable assessment of operative performance in laparoscopic gastric bypass procedures.

Publication types

  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Clinical Competence / standards*
  • Gastric Bypass / standards
  • Humans
  • Laparoscopy / standards*
  • Medical Errors* / classification
  • Observer Variation
  • Operative Time
  • Video Recording