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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., (© 2013 British Journal of Surgery Society Ltd. Published by John Wiley & Sons Ltd.)

Background: Ex vivo simulation-based technical skills training has been shown to improve operating room performance and shorten learning curves for basic laparoscopic procedures. The application of such training for laparoscopic Roux-en-Y gastric bypass (LRYGBP) has not been reviewed., Methods: Relevant studies were identified by one author from a search of MEDLINE and Embase databases from 1 January 1994 to 30 November 2010. Studies examining the learning curves and ex vivo training methods for LRYGBP were included; all other types of bariatric operations were excluded. A manual search of the references was also performed to identify additional potentially relevant papers., Results: Twelve studies (5 prospective and 7 retrospective case series) were selected for review. The learning curve for LRYGBP was reported to be 50-100 procedures. Bench-top laparoscopic jejunojejunostomy, anaesthetized animals and Thiel human cadavers made up the bulk of the reported models for ex vivo training. Most studies were of relatively poor quality. An evidence-based ex vivo training curriculum for LRYGBP is currently lacking., Conclusion: Better quality studies are needed to define the learning curve for LRYGBP. Future studies should focus on the design and validation of training models, and a comprehensive curriculum for training and assessment of cognitive, technical and non-technical components of competency for laparoscopic bariatric surgery., (Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.)