Lack of Progress – Absolutely no progress is made for an entire minute. Each minute spent dealing with the consequences of a predefined error represents lack of progress and should be evaluated as such.
Burn Non-target tissue – Any application of electrocautery to nontarget tissue.
Non-target structure injury – There is a perforation or tear of a non-target structure (i.e. liver, bowel, common duct) with or without associated bleeding or bile leakage. Injury in this instance does not include electrocautery along the surface, as this would be classified as burning non-target tissue.
Instrument out of view – A dissecting instrument with cautery capability is placed outside the field of view of the telescope such that the tip is unviewable. An instrument will be considered to have cautery capabilities at the moment that cautery is applied to tissue and at all times thereafter until the instrument is changed. Hook instruments are an exception in that they are considered to always have cautery capabilities. No error will be attributed to an incident of an instrument out of view as the result of a sudden telescope movement.
Attending takeover – The supervising attending surgeon takes the dissecting instrument or retracting instrument from the resident and performs a component of the procedure. The error occurs throughout the entire period the attending has control and each interval during this period will evaluated as such. The error ends once the resident resumes control of the instrument(s).
Gallbladder injury – There is gallbladder wall perforation with or without leakage of bile.
Cystic duct injury – There is a perforation or tear of the cystic duct indicated by leakage of bile.
Cystic artery injury – There is a perforation or tear of the cystic artery indicated by hemorrhage. Scoring continues until the hemorrhage is arrested. If a clip is applied, it is applied safely and appropriately, otherwise it is considered an error for the interval it was placed.
Inappropriate dissection – Dissection is conducted such that either (1) tearing of tissue occurs during dissection within the triangle of Calot, or (2) the plane of dissection within the triangle extends to include areas along the common bile duct.
Incorrect angle of gallbladder retraction – Retraction of gallbladder is provided such that dissection proceeds within an inadequately distracted, or “closed” Triangle of Calot prior to fenestration of triangle window.
Dropped retraction – Retracted tissue is suddenly dropped. Errors are counted only if re-grasping and retraction along a similar angle are subsequently required.