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Background <p>Near-miss events during paediatric laparoscopic fundoplication can affect surgical efficiency. This study aimed to classify near-miss events using the Generic Error Rating Tool (GERT) and evaluate their impact on procedure time.</p> Methods <p>A retrospective review of surgical videos and medical records was conducted for patients who underwent laparoscopic fundoplication between 2015 and 2024. The near-miss events were identified and categorised by two paediatric surgeons using the GERT. Inter-rater reliability was assessed using Cohen’s κ. The frequency and distribution of near-miss events were analysed across surgical steps, and the association between the number of near-miss events and procedure time was evaluated using multivariate linear regression analysis.</p> Results <p>Thirty-eight patients were included, and 170 near-miss events were identified. The most common events were bleeding or haematoma (<i>n</i> = 87, 51.2%), followed by thermal injury (<i>n</i> = 40, 23.5%) and entangled or broken sutures (<i>n</i> = 23, 13.5%). Events occurred most frequently during the surgical exposure of the diaphragmatic crura and oesophageal encirclement (<i>n</i> = 65, 38.2%). Rectification measures were required in 14.1% of events, with a median intervention time of 66.5&#xa0;s. Inter-rater agreement for event classification was substantial (Cohen’s κ = 0.83, <i>p</i> &lt; 0.001). A moderate positive correlation was observed between the number of near-miss events and procedure time (Spearman’s <i>r</i> = 0.43, <i>p</i> = 0.0072). Furthermore, multivariate linear regression analysis demonstrated a significant association between the number of near-miss events and prolonged procedure time (regression coefficient = 7.28, 95% confidence interval: 1.49–13.06, <i>p</i> = 0.015).</p> Conclusions <p>These findings indicate that near-miss events are significantly associated with longer procedure times in paediatric laparoscopic fundoplication. The application of the GERT offers a robust framework for understanding these errors and holds potential for enhancing surgical training. Addressing and mitigating such events may contribute to optimising surgical efficiency and improving patient safety.</p>

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Deciphering near-miss events in paediatric laparoscopic fundoplication: a video-based analysis of mechanisms and consequences

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月29日

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  • Yohei Sanmoto,
  • Yudai Goto,
  • Kazuki Shirane,
  • Kouji Masumoto

摘要

Background

Near-miss events during paediatric laparoscopic fundoplication can affect surgical efficiency. This study aimed to classify near-miss events using the Generic Error Rating Tool (GERT) and evaluate their impact on procedure time.

Methods

A retrospective review of surgical videos and medical records was conducted for patients who underwent laparoscopic fundoplication between 2015 and 2024. The near-miss events were identified and categorised by two paediatric surgeons using the GERT. Inter-rater reliability was assessed using Cohen’s κ. The frequency and distribution of near-miss events were analysed across surgical steps, and the association between the number of near-miss events and procedure time was evaluated using multivariate linear regression analysis.

Results

Thirty-eight patients were included, and 170 near-miss events were identified. The most common events were bleeding or haematoma (n = 87, 51.2%), followed by thermal injury (n = 40, 23.5%) and entangled or broken sutures (n = 23, 13.5%). Events occurred most frequently during the surgical exposure of the diaphragmatic crura and oesophageal encirclement (n = 65, 38.2%). Rectification measures were required in 14.1% of events, with a median intervention time of 66.5 s. Inter-rater agreement for event classification was substantial (Cohen’s κ = 0.83, p < 0.001). A moderate positive correlation was observed between the number of near-miss events and procedure time (Spearman’s r = 0.43, p = 0.0072). Furthermore, multivariate linear regression analysis demonstrated a significant association between the number of near-miss events and prolonged procedure time (regression coefficient = 7.28, 95% confidence interval: 1.49–13.06, p = 0.015).

Conclusions

These findings indicate that near-miss events are significantly associated with longer procedure times in paediatric laparoscopic fundoplication. The application of the GERT offers a robust framework for understanding these errors and holds potential for enhancing surgical training. Addressing and mitigating such events may contribute to optimising surgical efficiency and improving patient safety.