Simulation in laparoscopic surgery: a concurrent validity study for FLS

Current assessments using the fundamentals of laparoscopic surgery (FLS) tasks are labour intensive and depend heavily on expert raters. Hand motion analysis may offer an alternative method of objective evaluation of FLS performance.

The aim of this study was to assess whether a correlation exists between the expert rated assessments of the FLS tasks and computer-based assessment of motion efficiency using the Imperial College surgical assessment device (ICSAD).

We recruited 26 volunteer subjects who were stratified into three experience groups: juniors (PGY1-3) (N = 13), seniors (PGY4,5) (N = 7) and staff surgeons (N = 6). All subjects performed four FLS tasks: (1) peg transfer, (2) pattern cut, (3) endoloop and (4) intracorporeal suturing. Performance was assessed by both standard FLS expert rating and motion analysis using ICSAD. Group differences were analyzed using the Kruskal-Wallis test, and Spearman coefficient analyses were employed to compare FLS and ICSAD scores.

FLS expert-derived scores discriminated effectively between experience groups for all tasks (p < 0.05). Motion efficiency scores discriminated between experience groups for tasks 1, 3 and 4 for number of movements (p < 0.05), tasks 1 and 4 for total distance (p < 0.05) and tasks 1, 2, 3 and 4 for total time (p < 0.005). There was a significant correlation between total FLS expert scores and the motion efficiency metrics of total distance, number of movements and total time (Spearman coefficient and p values of 0.81, < 0.001; 0.76; < 0.001; and 0.93, < 0.001, respectively).

There is a high correlation between FLS standard scoring and motion efficiency metrics. The use of ICSAD for the objective assessment of FLS tasks may in the future offer an adjunctive method of evaluation. ICSAD metrics are potentially less labour intensive due to the instant and fully automated computerized scoring that it provides.