Surgical Endoscopy

, Volume 28, Issue 5, pp 1535–1544 | Cite as

International consensus on safe techniques and error definitions in laparoscopic surgery

  • Esther M. BonrathEmail author
  • Nicolas J. Dedy
  • Boris Zevin
  • Teodor P. Grantcharov



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.


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.


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.


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.


Education Laparoscopic surgery Technical error Adverse event 



We thank the members of the expert panel for lending their expertise to the consensus process. These members include Hendrik J. Bonjer, Nicolas Christou, Liane S. Feldman, Peter Funch Jensen, Michel Gagner, Hans Lönroth, Joseph Mamazza, Mario Morino, Torsten Olbers, John Paige, Raul J. Rosenthal, Marlies Schijven, Christopher M. Schlachta, Nathaniel J. Soper, Dimitrios Stefanidis, Shawn Tsuda, Markus Utech, Bruce Wolfe, Tonia M. Young-Fadok, as well as those who wish to remain anonymous. This work was supported by an educational research Grant from Johnson & Johnson Medical Companies Canada and the Ontario Research Fund (ORF) (Drs. Bonrath, Dedy, and Grantcharov). Dr. Zevin is supported by the Royal College of Physicians and Surgeons of Canada Fellowship for Studies in Medical Education.


Esther M Bonrath, Nicolas J Dedy, Boris Zevin, and Teodor P Grantcharov have no conflicts of interest to disclose.


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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Esther M. Bonrath
    • 1
    • 2
    Email author
  • Nicolas J. Dedy
    • 1
    • 2
  • Boris Zevin
    • 3
  • Teodor P. Grantcharov
    • 1
    • 2
    • 3
  1. 1.Institute of Medical ScienceUniversity of TorontoTorontoCanada
  2. 2.Division of General SurgerySt. Michael’s HospitalTorontoCanada
  3. 3.Department of SurgeryUniversity of TorontoTorontoCanada

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