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A Task-Specific Performance Rating Scale for Laparoscopic Intracorporeal Suturing and Knot Tying: Development and
Xiang Xia1, Zihan Zhou2, Yihong Lu1
1Department of Gastrointestinal Surgery, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China.
Background:
Laparoscopic intracorporeal suturing and knot tying is a core minimally invasive surgical skill, but generic global rating instruments may not identify the task-specific technical errors needed for targeted feedback. We developed an 8-item performance rating scale for a standardized simulator task and evaluated its measurement properties.
Methods:
In a cross-sectional cohort, 82 participants across 5 training levels completed 1 interrupted laparoscopic suture consisting of 1 needle pass, 3 intracorporeal knots, and final cutting. Deidentified videos were independently scored by 3 raters. Interrater reliability was estimated using 2-way random effects, absolute-agreement intraclass correlation coefficients (ICCs). Between-level performance was assessed using Kruskal-Wallis tests, Holm-adjusted pairwise comparisons, and Spearman correlation. Twelve learners completed the task before and after standardized training.
Results:
Quality scores differed across training levels (P < .001) and correlated strongly with level (Spearman rho = 0.872, P < .001). Completion time decreased with level (rho = -0.897, P < .001). Total-score reliability was excellent (ICC[2,1] = 0.960; ICC[2,3] = 0.986). After training, mean quality score increased by 5.83 points, and completion time decreased by 29.17 seconds (both P < .001).
Conclusions:
The scale provides a reliable, reproducible method for video-based assessment of laparoscopic intracorporeal suturing and knot-tying performance. Its principal current use is to differentiate novice and early-stage operators and to track progress during simulator-based practice. More demanding tasks and multicenter evaluation are needed before use for advanced proficiency decisions.
