Development and Validation of a Surgical Performance Assessment Scale for Lung Lobectomy and Lymph Node Dissection

Assessing surgical trainees' performance requires objective, validated, and reliable evaluation tools. We developed and validated the Lung Lobectomy Performance Assessment Scale Score (LOB-PASS) to objectively evaluate lung lobectomy performance, including lymph node dissection, across different surgical approaches (postero-lateral thoracotomy, video-assisted, and robot-assisted).

The LOB-PASS scale was developed using the Delphi consensus method and response process testing in simulation sessions. Validation was performed on 48 thoracic surgery residents, assessed by independent observers through simulation-based response testing. Internal structure was evaluated using Cronbach's alpha, intraclass correlation coefficient (ICC), correlation scores from linear regression (R2), and Bland-Altman analysis. Inter-observer score comparisons were conducted using the Wilcoxon test and the F-test.

The final scale included 52 items categorized into seven domains: opening (n = 6), cavity exploration and lymph node dissection (n = 12), vein time (n = 5), arterial time (n = 8), bronchial time (n = 6), parenchymal time (n = 7), and closure (n = 8), with a total score of 104 points. Internal structure analysis was based on 48 simulation procedures: Cronbach's alpha = 0.89, ICC = 0.92, R2 = 0.84. No significant inter-observer differences were found (P > .05). Bland-Altman analysis demonstrated a mean difference of 0.19, with 95% limits of agreement ranging from -13.3 to 13.7.

LOB-PASS is a valid and reliable tool for assessing lung lobectomy performance with lymph node dissection across all surgical approaches. Integrating LOB-PASS into surgical training curricula could standardize competency assessment and optimize technical skill acquisition in thoracic surgery.