Defining technical errors in laparoscopic surgery: a systematic review

Background Technical errors, a distinct subcomponent of surgical proficiency, have a significant impact on patient safety and clinical outcomes. To date, only a few studies have been designed to describe and evaluate these errors. This review was performed to assess technical errors described in laparoscopic surgery. Methods A literature search of Medline, Cochrane, EMBASE, and OVID databases (1946–2012, week 14) using the terms “technical/medical error,” “technical skill,” and “adverse event” in combination with the terms “laparoscopy/laparoscopic surgery” was conducted. English language peer review articles with a description of technical errors were included. Opinion papers, reviews, and articles not addressing laparoscopic surgery were excluded. Results The search returned 2,282 articles. Application of the inclusion criteria reduced the number of articles to 21. Of these 21 articles, 14 (67 %) were observational studies, 3 (14 %) were randomized trials, 2 (10 %) were prospective interventional studies, and 2 (10 %) were retrospective analyses. Eight articles (38 %) applied error analysis as an approach to determine error rates within routine procedures. The remaining 13 articles (62 %) used the assessment of errors to describe and quantify surgical skill in an educational setting. Conclusions A number of approaches for the assessment of surgical technical errors exist. The error definitions vary greatly, making a comparison of error rates between groups impossible. Complexity of scale design and subjectivity in ratings have resulted in limited use of these scores outside the experimental setting. To facilitate error analysis as a self-assessment method of continuous learning and quality control, further research and better tools are required.