Assessing operative performance in advanced laparoscopic colorectal surgery.

Area of Science:

• Surgical Education
• Minimally Invasive Surgery
• Colorectal Surgery

Background:

• Assessing technical skills in complex laparoscopic colorectal surgery is crucial for patient outcomes.
• Current assessment methods may not fully capture the nuances of advanced procedures.
• A validated tool is needed for objective evaluation in the operating room.

Purpose of the Study:

• To develop and validate a novel tool for assessing generic and specific technical skills.
• To evaluate the tool's reliability and validity in advanced laparoscopic colorectal surgery.
• To differentiate skill levels between experienced surgeons and trainees.

Main Methods:

• Hierarchical task analysis was used to define skills for three key operations: right hemicolectomy, sigmoid colectomy, and anterior resection.
• Likert scales were developed based on task analysis to assess generic and specific technical skills.
• Two experienced surgeons independently and blindly assessed 84 live surgical operations.

Main Results:

• The assessment tool demonstrated high inter-rater reliability (ICC 0.94 for generic, 0.88 for specific skills).
• Significant construct validity was confirmed for both generic and specific skills (ANOVA, P < 0.05).
• Consultants consistently outperformed trainees in both generic and specific technical skills.

Conclusions:

• The developed tool is reliable and possesses face, content, concurrent, and construct validities.
• This assessment instrument is suitable for evaluating technical proficiency in advanced laparoscopic colorectal surgery.
• The tool can serve as a valuable resource for surgical training and performance appraisal.