title: Technical skills errors in laparoscopic cholecystectomy by expert surgeons.
abstract: BACKGROUND
  Performing laparoscopic surgery involves a complex cascade of cognitive skills, which may inherently have a constant technical error rate. We assess generic and specific minor and major error rates in laparoscopic cholecystectomies (LCs) performed by consultant surgeons.
  
  
  METHODS
  Checklists of generic (11) and specific technical minor (six) and major events (eight) were devised for LCs. Two experienced surgeons assessed each full-length operation blindly and independently.
  
  
  RESULTS
  A total of 37 LCs were performed by eight consultants. There were no major intraoperative or postoperative complications. Mean inter-rater reliability was kappa = 0.91 (range 0.80-0.98) for each of the error categories. Error rates were generic (27/407) 6.6%, minor (59/222) 26.6%, and major (8/296) 2.7%, respectively. There was a significant statistical difference between the minor error group and the other groups, p <or= 0.05.
  
  
  CONCLUSIONS
  Performing laparoscopic surgery may always have a background technical error rate. Our present study demonstrates a migration of surgical technical errors in expert laparoscopic surgeons. The surgeons migrate technically when they execute a high rate of procedure-specific minor errors. However, when it comes to the major fundamental aspects of the operation, they dynamically adapt and migrate away from performing major technical errors. We aim to continue the study to increase cases, assess trainees as well, and also explore other factors that may affect the surgeon when executing surgical technical tasks.
authors.affiliation: Surgical Skill and Technology Unit, Clinical Safety Research Unit, Department of Surgical Oncology and Technology, St. Mary's Hospital, Imperial College, London. s.sarker@imperial.ac.uk
authors.forename: S K
authors.initials: SK
authors.lastname: Sarker
authors.forename: A
authors.initials: A
authors.lastname: Chang
authors.forename: C
authors.initials: C
authors.lastname: Vincent
authors.forename: A W
authors.initials: AW
authors.lastname: Darzi
mesh_terms: D000328:Adult; D017081:Cholecystectomy, Laparoscopic / Q000592:standards*; D002983:Clinical Competence / Q000592:standards*; D005260:Female; D013502:General Surgery / Q000592:standards*; D006801:Humans; D008297:Male; D019300:Medical Errors; D008875:Middle Aged