Development of Nontechnical Skills Assessment Tool and The Validation Study for Laparoscopic Inguinal Hernia Repair

Nontechnical skills, such as situational awareness and decision-making, are essential for safe and efficient surgical performance. Although the Nontechnical Skills for Surgeons (NOTSS) framework provides a structured approach, it lacks procedure-specific assessment tools. There remains a significant gap in standardized methods for evaluating and training nontechnical skills in specific surgical procedures.

To develop and validate a novel assessment tool, KUDAS-TAPP (Kurashima Decision-making and Situation awareness - Trans Abdominal Preperitoneal approach), specifically designed to evaluate nontechnical skills in the TAPP procedure, focusing on situational awareness and decision-making.

Under the supervision of expert hernia surgeons, we developed the KUDAS-TAPP as an assessment tool for nontechnical skills in TAPP. This tool was used to evaluate 3 groups of surgeons: novices, intermediates, and experts. Participants were assessed by 3 independent raters using the KUDAS-TAPP. Inter-rater reliability was analyzed using the intraclass correlation coefficient (ICC), and construct validity was examined by comparing scores across experience levels.

A total of 21 participants (5 novices, 10 intermediates, and 6 experts) from 11 institutions were included. The inter-rater reliability of KUDAS-TAPP was high (ICC = 0.91, 95% confidence interval (CI) : 0.84 - 0.96), and internal consistency was excellent (Cronbach's alpha = 0.97). The median KUDAS-TAPP scores differed significantly across experience levels (p < 0.01), with significant differences between novices and experts, and intermediates and experts (p < 0.01). KUDAS-TAPP scores correlated strongly with the number of TAPP procedures performed (ρ = 0.73, p < 0.01), as well as with Global Operative Assessment of Laparoscopic Skills for Groin Hernia (GOALS-GH) (ρ = 0.88, p < 0.01) and TAPP checklist scores (ρ = 0.80, p < 0.01).

The KUDAS-TAPP is a reliable and valid assessment tool for evaluating situational awareness and decision-making in the TAPP procedure. Its application could enhance surgical education and training by providing a structured framework for assessing and improving nontechnical skills. Future research should explore its effectiveness in training programs and adaptability to other surgical procedures.