Analysis of errors in laparoscopic surgical procedures.
BACKGROUND
The determination of laparoscopic surgeon ability is essential to training error avoidance. The present study describes a practical method of surgical error analysis.


METHODS
After review of practice videotapes of the excisional phase of laparoscopic cholecystectomy, consensus on the identification of eight errors was achieved. Interrater agreement at the end of this phase was 84-96%. Fourteen study videotapes of gallbladder excision were then observed independently by expert reviewers blinded to surgical team identity. Procedures were assessed using a scoring matrix of 1-min segments with each error reported each minute.


RESULTS
Interrater agreement was 84-100% for all error categories.


CONCLUSIONS
The present study demonstrates that excellent interrater agreement of procedural errors can be achieved by carefully defining and training recognition of targeted events. Extension of this simple and reliable analysis tool to other procedures should be feasible to define behaviors leading to adverse clinical outcomes.
Seymour
N E
NE
Department of Surgery, Yale University School of Medicine, 330 Cedar Street, New Haven, CT 06520-8062, USA. neal.seymour@bhs.org
Gallagher
A G
AG
Roman
S A
SA
O'Brien
M K
MK
Andersen
D K
DK
Satava
R M
RM
D002056:Burns / Q000209:etiology; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000706:statistics & numerical data*; D002983:Clinical Competence; D004210:Dissection / Q000009:adverse effects; D004564:Electrocoagulation / Q000009:adverse effects; D005240:Feasibility Studies; D013502:General Surgery / Q000193:education; D006801:Humans; D007396:Internship and Residency; D007431:Intraoperative Complications / Q000209:etiology; D008099:Liver / Q000293:injuries; D019300:Medical Errors / Q000706:statistics & numerical data; D015588:Observer Variation; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016037:Single-Blind Method; D014743:Videotape Recording