Surgical Endoscopy

, Volume 32, Issue 9, pp 3822–3829 | Cite as

EAES classification of intraoperative adverse events in laparoscopic surgery

  • N. K. FrancisEmail author
  • N. J. Curtis
  • J. A. Conti
  • J. D. Foster
  • H. J. Bonjer
  • G. B. Hanna
  • on behalf of the EAES committees



Surgical outcomes are traditionally evaluated by post-operative data such as histopathology and morbidity. Although these outcomes are reported using accepted systems, their ability to influence operative performance is limited by their retrospective application. Interest in direct measurement of intraoperative events is growing but no available systems applicable to routine practice exist. We aimed to develop a structured, practical method to report intraoperative adverse events enacted during minimal access surgical procedures.


A structured mixed methodology approach was adopted. Current intraoperative adverse event reporting practices and desirable system characteristics were sought through a survey of the EAES executive. The observational clinical human reliability analysis method was applied to a series of laparoscopic total mesorectal excision (TME) case videos to identify intraoperative adverse events. In keeping with survey results, observed events were further categorised into non-consequential and consequential, which were further subdivided into four levels based upon the principle of therapy required to correct the event. A second survey phase explored usability, acceptability, face and content validity of the novel classification.


217 h of TME surgery were analysed to develop and continually refine the five-point hierarchical structure. 34 EAES expert surgeons (69%) responded. The lack of an accepted system was the main barrier to routine reporting. Simplicity, reproducibility and clinical utility were identified as essential requirements. The observed distribution of intraoperative adverse events was 60.1% grade I (non-consequential), 37.1% grade II (minor corrective action), 2.4% grade III (major correction or change in post-operative care) and 0.1% grade IV (life threatening). 84% agreed with the proposed classification (Likert scale 4.04) and 92% felt it was applicable to their practice and incorporated all desirable characteristics.


A clinically applicable intraoperative adverse event classification, which is acceptable to expert surgeons, is reported and complements the objective assessment of minimal access surgical performance.


Adverse events Classification Laparoscopic Morbidity Intraoperative EAES 



EAES research grant awarded to NKF for the 2D/3D trial (ISRCTN59485808).

Compliance with ethical standards


Prof Francis, Mr Curtis, Mr Conti, Mr Foster, Prof Bonjer and Prof Hanna confirm they hold no conflicts of interest or financial ties in relation to this manuscript. All collaborative authors also confirm no financial ties or conflicts of interest to disclose.

Supplementary material

464_2018_6108_MOESM1_ESM.docx (14 kb)
Supplementary material 1 (DOCX 15 KB)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of General SurgeryYeovil District Hospital NHS Foundation Trust, Higher KingstonYeovilUK
  2. 2.Faculty of ScienceUniversity of BathBathUK
  3. 3.Department of Surgery and CancerImperial College LondonLondonUK
  4. 4.Department of Colorectal SurgeryQueen Alexandra HospitalPortsmouthUK
  5. 5.Academic Surgical UnitUniversity of SouthamptonSouthamptonUK
  6. 6.Department of SurgeryVU University Medical CentreAmsterdamThe Netherlands

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