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Clinical Application of Single-Surgeon, Three-Port, Laparoscopic Resection for Colorectal Cancer with Natural Orifice Specimen Extraction

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The Predictive Value of Basic Laparoscopic Evaluations on Complex Cases Using the Society for Improving Medical

Jeremy A Balch¹, Stefanie S Sebok-Syer², Kayla Marcotte³

¹Department of Surgery, University of Florida, Gainesville, Florida; Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida.

The Journal of Surgical Research

|May 28, 2025

Summary

Surgical residents' basic laparoscopic skills moderately predict complex procedure performance. However, postgraduate year alone offers similar predictive value, suggesting basic skill assessment may not significantly enhance complex procedure readiness prediction.

Keywords:

Competency-based medical education Component skills Entrustable professional activities Machine learning Surgical education

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Area of Science:

Surgical Education
Medical Simulation
Machine Learning in Medicine

Background:

The assumption that basic surgical skills transfer to complex procedures remains untested in resident training.
Board certification relies on the unverified premise of skill transference from basic to advanced surgical techniques.

Purpose of the Study:

To evaluate if prior performance in basic laparoscopic procedures can predict resident success in their first complex laparoscopic procedure.
To assess the predictive efficacy of basic laparoscopic skill assessment for complex surgical task performance.

Main Methods:

A retrospective analysis of 7792 attending evaluations for 899 general surgery residents from 2016-2023.
Utilized the Society for Improving Medical Procedural Learning collaborative operating room database.
Applied five machine learning algorithms to predict performance on the first complex procedure based on cumulative basic procedure instances, categorizing procedures by Accreditation Council on Graduate Medical Education definitions.

Main Results:

The best random forest model, using 3 prior basic procedures, achieved a mean squared error of 0.23.
Resident postgraduate year was identified as the most significant predictor.
Univariate regression using postgraduate year alone yielded a mean squared error of 0.33, indicating limited additional predictive value from basic procedure ratings.

Conclusions:

Basic laparoscopic procedure performance ratings demonstrated moderate effectiveness in predicting subsequent complex procedure performance.
Predictive value of basic laparoscopic skills was minimal when considered alongside postgraduate year, suggesting postgraduate year is a stronger predictor.