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

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.