Sanmoto Yohei, Kawami Akio, Matsumoto Masanaga, Masumoto Kouji
Department of Pediatric Surgery, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, 305-8576, Japan.
Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan.
Surg Endosc. 2025 Jul 18. doi: 10.1007/s00464-025-12022-7.
We aimed to evaluate the feasibility, reliability, and educational utility of applying the generic error rating tool (GERT) for identifying intraoperative technical errors and assessing technical proficiency during pediatric single-incision laparoscopic percutaneous extraperitoneal closure (SILPEC) procedures.
This retrospective observational study conducted at a single tertiary-care university hospital included 25 pediatric patients (< 16 years) who underwent unilateral SILPEC procedures with complete operative video recordings between January and December 2022. Surgical technical performance was independently assessed using the GERT and objective structured assessment of technical skill (OSATS) frameworks by two blinded pediatric surgeons. Inter-rater reliability was analyzed using intraclass correlation coefficients (ICCs). Based on the median OSATS score as a cut-off, cases were further categorized into high- and low-performance groups, and the association between GERT-derived error metrics and technical proficiency was evaluated.
A mean total of 273 errors and 32 events were identified across all procedures. GERT demonstrated excellent inter-rater reliability for total errors (ICC = 0.92) and total events (ICC = 0.97). GERT error counts showed a strong negative correlation with OSATS scores for both evaluators: Spearman's ρ = - 0.78 (P < 0.001) for evaluator 1 and ρ = - 0.63 (P < 0.001) for evaluator 2. Compared with the high-performance group (OSATS > 26), the low-performance group exhibited significantly more errors (median 13 vs. 8.5) and events (median 1 vs. 0.5) per procedure (P = 0.0016 and P = 0.032, respectively). Errors and events were disproportionately concentrated during suturing along the outer semicircle of the hernia orifice.
GERT demonstrated high feasibility and excellent inter-rater reliability for assessing technical performance in pediatric SILPEC. Its structured error profiling correlated with global performance scores and enabled detailed identification of intraoperative errors, supporting tailored formative feedback and continuous skill development in pediatric surgical education.
我们旨在评估应用通用错误评级工具（GERT）来识别小儿单切口腹腔镜经皮腹膜外闭合术（SILPEC）过程中的术中技术错误并评估技术熟练程度的可行性、可靠性和教育实用性。
这项在一家三级医疗大学医院进行的回顾性观察研究纳入了25例年龄小于16岁的小儿患者，这些患者在2022年1月至12月期间接受了单侧SILPEC手术，并有完整的手术视频记录。由两名不知情的小儿外科医生使用GERT和客观结构化技术技能评估（OSATS）框架独立评估手术技术表现。使用组内相关系数（ICC）分析评分者间信度。以OSATS评分中位数作为分界点，将病例进一步分为高绩效组和低绩效组，并评估GERT得出的错误指标与技术熟练程度之间的关联。
在所有手术中平均共识别出273个错误和32个事件。GERT在总错误数（ICC = 0.92）和总事件数（ICC = 0.97）方面表现出出色的评分者间信度。GERT错误计数与两位评估者的OSATS评分均呈强烈负相关：评估者1的Spearman ρ = -0.78（P < 0.001），评估者2的ρ = -0.63（P < 0.001）。与高绩效组（OSATS > 26）相比，低绩效组每例手术的错误（中位数13对8.5）和事件（中位数1对0.5）明显更多（P分别为0.0016和0.032）。错误和事件在沿疝孔外半圆缝合时不成比例地集中。
GERT在评估小儿SILPEC技术表现方面显示出高可行性和出色的评分者间信度。其结构化的错误剖析与整体表现评分相关，并能够详细识别术中错误，支持小儿外科教育中的针对性形成性反馈和持续技能发展。
