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Validity and reliability evidence support task-specific metrics for laparoscopic fundoplication.

Alexis Desir^1,2, Carolina Marques², Emile Farah¹

¹Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA.

Surgical Endoscopy

|February 21, 2024

Summary

This study developed and validated task-specific metrics for laparoscopic hiatal hernia repair (LHHR) simulation. These metrics show reliability and validity, crucial for advancing virtual reality surgical training.

Keywords:

Nissen fundoplication Surgical education Task-specific metrics VR simulator

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Area of Science:

Surgical Education
Medical Simulation
Minimally Invasive Surgery

Background:

Laparoscopic hiatal hernia repair (LHHR) is a complex surgical procedure demanding specialized training.
Surgical simulation offers a viable method for acquiring complex surgical skills without extensive patient volume.
Current limitations exist in task-specific metrics for LHHR simulation development.

Purpose of the Study:

To develop task-specific metrics (TSM) for the fundoplication phase of LHHR.
To assess the validity and reliability of these TSM.
To lay the groundwork for a virtual reality (VR) simulator for LHHR.

Main Methods:

Phase I involved expert surgeon interviews to define TSM.
Phase II utilized a porcine stomach explant model for laparoscopic Nissen fundoplication.
Participants of varying expertise levels performed the procedure, with blinded graders assessing performance using global and TSM.

Main Results:

High interrater reliability (IRR) was observed for both global (ICC=0.84) and TSM (ICC=0.75).
Significant performance differences were found between surgical expertise groups for both metric types (p<0.001).
A strong positive correlation (rs=0.86) existed between global and TSM, indicating construct validity.

Conclusions:

Task-specific metrics for LHHR were successfully developed and demonstrated significant reliability and validity.
These metrics are suitable for use in a virtual reality simulator for LHHR training.
The developed metrics are expected to enhance surgical training for laparoscopic hiatal hernia repair.