A Video-Based Procedure-Specific Competency Assessment Tool for Minimally Invasive Esophagectomy

Area of Science:

• Surgical Education
• Medical Device Development
• Quality Improvement in Surgery

Background:

• Minimally invasive esophagectomy (MIE) is a complex surgical procedure with a steep learning curve.
• Suboptimal surgical performance in complex minimally invasive procedures is linked to poorer patient outcomes.

Purpose of the Study:

• To develop and validate a procedure-specific competency assessment tool (CAT) for minimally invasive esophagectomy (MIE).

Main Methods:

• An international quality improvement study developed and validated a MIE-CAT with 8 procedural phases and 4 quality components scored on a Likert scale.
• 18 international MIE experts peer-reviewed 32 intraoperative MIE videos to assess feasibility, validity, and reliability.
• MIE-CAT version 2 was refined to enhance interrater reliability.

Main Results:

• Experts found the MIE-CAT feasible and easy to use, demonstrating good intrarater reliability (ICCs 0.807-0.898).
• Interrater reliability was moderate (ICCs 0.536-0.705), with discrepancies mainly in lymphadenectomy phases.
• Construct validity was supported by correlations between MIE-CAT scores and surgical experience, blood loss, operative time, and complication rates.

Conclusions:

• The developed MIE-CAT is feasible and validated for assessing MIE surgical performance.
• The MIE-CAT provides valuable insights for clinical practice, surgical training, and research in MIE.