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Published on: November 12, 2021
Can Intraoperative Video Recordings Contribute to Improving Laparoscopic Percutaneous Extraperitoneal Closure in
Go Miyano1, Shunsuke Yamada1, Katherine Barsness2
1Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Insights
This study evaluated intraoperative video recordings of laparoscopic percutaneous extraperitoneal closure (LPEC) for pediatric inguinal hernias. Advanced reviewers showed significant score variance, questioning if surgical experience alone guarantees improved technique.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Surgical Performance Evaluation
Background:
- Laparoscopic percutaneous extraperitoneal closure (LPEC) is a common technique for pediatric inguinal hernias.
- Objective assessment of surgical performance using intraoperative video recordings (IVRs) is crucial for quality improvement.
- Surgeon experience level is often presumed to correlate with surgical outcomes.
Purpose of the Study:
- To assess surgical performance in pediatric LPEC using IVRs.
- To evaluate the correlation between reviewer experience and objective surgical scoring.
- To determine if advanced surgical experience translates to better performance metrics and lower recurrence risk.
Main Methods:
- 183 IVRs of pediatric LPEC were blindly reviewed by panels of surgeons with varying experience (advanced, intermediate, basic).
- Reviewers scored specific surgical aspects (suturing, dissection, bleeding, etc.) and assigned a recurrence risk rank (RRR).
- Score variance between reviewers and correlation with RRR were statistically analyzed.
Main Results:
- One recurrence was observed in an 'easy' graded case.
- Advanced reviewers (Group A) showed the greatest score variance, particularly in difficult cases.
- Reviewer A's scores for suturing and bleeding, and Reviewer I's for dissection and peritoneal injury, correlated with RRR; Reviewer B's did not.
Conclusions:
- Surgical experience alone may not consistently improve objective performance metrics in pediatric LPEC.
- Significant variance among advanced reviewers suggests potential subjectivity in performance assessment.
- Further research is needed to refine objective criteria for evaluating surgical technique and outcomes in LPEC.
Abstract:
We reviewed intraoperative video recordings (IVRs) of laparoscopic percutaneous extraperitoneal closure (LPEC) for inguinal hernia in children blindly to assess performance. IVRs of 183 LPEC performed between April 2013 and March 2016, graded by the operating surgeon as difficult (D; n = 8), straightforward (S; n = 96), or easy (E; n = 79), were scored by a panel of reviewers with advanced (group A; >400 LPEC cases; n = 5), intermediate (group I; 50-150 cases; n = 5), and basic (group B; <10 cases; n = 5) experience, according to suturing, dissection plane, vas/vessel dissection, bleeding, and peritoneal injury. They also allocated a recurrence risk rank (RRR; highest = 6; lowest = 1) for each IVR. Mean score variance for each IVR was also compared between reviewers. There was one recurrence (R; 4-year-old male; level E). RRR were: 1, 2, and 2 for reviewers A, I, and B, respectively. Reviewer A scores for "suturing" and "bleeding," and reviewer I scores for "dissection plane" and "peritoneal injury" correlated significantly with RRR. No reviewer B scores correlated with RRR. Score variance between A and I and A and B for cases D1 and D2 were statistically significant. Advanced reviewers showed greatest variance, questioning the validity of whether experience alone improves surgical technique.
