Assessing Operative Performance in Advanced Laparoscopic Colorectal Surgery

Abstract

Competent technical skills performance in complex operations is vital for satisfactory patient outcome. Assessing these skills is therefore of paramount importance. In this study we aim to develop and validate a new tool that can assess both generic and specific technical skills in advanced complex laparoscopic colorectal surgery in the operating room. Hierarchical task analysis was constructed for generic and specific technical skills on three key advanced laparoscopic colorectal operations (right hemicolectomy, sigmoid colectomy, and anterior resection) after expert discussions. Likert scales were then constructed individually for generic and specific technical skills for each operation using hierarchical task analysis for each operation to identify key elements and steps for each operation. Each operation was assessed independently and blindly by two experienced surgeons. Eighty-four live real operations performed by six consultants and eight trainees were assessed. Interclass correlation coefficient between the two observers was 0.94 (P < or = 0.05) for generic technical skills and 0.88 (P < or = 0.05) for the operation-specific technical skills. Construct validity for both generic and specific technical skills for consultants and trainees was significant using ANOVA (P < or = 0.05). All consultants therefore consistently performed better in both generic and specific technical skills compared to their trainees. This new assessment tool of generic and specific technical skills in advanced laparoscopic colorectal surgery is reliable and has face, content, concurrent, and construct validities. The tool has the possibility of being used as a surgical training and appraisal tool.