International consensus on safe techniques and error definitions in laparoscopic surgery

Surg Endosc. 2014 May;28(5):1535-44. doi: 10.1007/s00464-013-3348-y. Epub 2013 Dec 20.


Background: Definitions of errors and poor technique in laparoscopic surgery are lacking in modern clinical practice. As a result, educators often base their teaching on personal experience and individual preferences. The objective of this study was to achieve expert consensus regarding these definitions in order to provide a framework for a standardized approach to teaching safe technique and avoiding common errors in laparoscopic surgery.

Methods: A Delphi survey was conducted with an international panel of experts in laparoscopic surgery. Survey items for definitions and examples of errors and resulting injuries (events) were derived from literature reviews and procedural observations. An online platform was used to administer the survey. Experts were requested to rate their level of agreement regarding survey items on a 5-point Likert-type scale; additional comments were facilitated through free-text entries. Consensus was defined as Cronbach's α > 0.70. Items that were rated ≥ 3 ("somewhat agree") by 75 % or more of the panel were included in the consensus list. The Delphi process was continued until all subsections of the survey met the defined consensus level.

Results: Two survey rounds were completed with 33 experts from 12 countries (round 1) and 25 experts from nine countries (round 2). Overall consensus was high for both rounds (α = 0.9). Seventeen definitions and 39 examples of errors and events were included in the final consensus list.

Conclusions: Standardized definitions and examples of technical errors in laparoscopic surgery were established using a consensus-based approach. These definitions can serve as uniform nomenclature and can be used by educators as a reference guide to ensure standardization in surgical training and performance assessment.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Attention / physiology*
  • Clinical Competence / standards*
  • Cognition / physiology*
  • Computer Simulation
  • Consensus*
  • Delphi Technique
  • Education, Medical, Continuing*
  • Female
  • Humans
  • Internship and Residency / methods*
  • Laparoscopy / education
  • Laparoscopy / psychology*
  • Male
  • Reference Standards
  • Task Performance and Analysis
  • Workload
  • Young Adult