Introduction/Background Advanced surgery in oncological settings is often grouped for analysis based on morbidity and mortality data (MMD). However, MMD has not been able to reduce adverse clinical outcomes, because it doesn’t identify errors enacted during the intra-operative periods. We conducted a feasibility study to objectively assess surgical skills and measure enacted errors and near misses in minimally invasive hysterectomy.

Methodology We conducted a multicenter prospective cohort study. Inclusion criteria included any patient undergoing (robotic-assisted) laparoscopic hysterectomy for oncological indication. Procedures were videorecorded and objective assessment of surgical skills through error analysis was conducted using the Objective Clinical Human reliability analysis (OCHRA), the Global Evaluative Assessment of Robotic Skills (GEARS) and the Global Operative Assessment of Laparoscopic Skills (GOALS)by blinded and experienced annotators. An error was defined as an unintended intra-operative event due to a technical error. A near miss was identified as an error without clinical consequence. A hierarchical task analysis was created for (robotic-assisted) laparoscopic hysterectomy.

Results Twenty procedures were analysed and manually annotated for this feasibility study. Indications for operation included endometrial cancer (85%), cervical cancer (5%), ovarian cancer (5%) and borderline ovarian tumor (5%). The mean number for errors per video was 25.0 errors (sd +/- 12.0) and 18.2 near misses (sd +/-10.5). A positive correlation was seen between the number of errors and postoperative complication rate (Pearson Correlation: 0.4, P = 0.87)). A strong negative correlation was measured between the error analysis and GEARS and GOALS score: r = -0.81, P < 0.033).

Conclusion The OCHRA methodology can be applied to objectively assess operative skills in minimally invasive hysterectomies. This feasibility analysis shows that our objective assessment tool has the potential to correlate surgical skills with postoperative clinical outcomes.

Disclosures All authors report no conflict of interest.