Rating of camera navigation skills in colorectal surgery

F Huettl,Tobias Huber,N Wachter,H Lang,F Watzka,M Paschold,W Kneist,B Hensel

doi:10.1007/s00384-020-03543-9

Abstract

PurposeIn advanced minimally invasive surgery the laparoscopic camera navigation (LCN) quality can influence the flow of the operation. This study aimed to investigate the applicability of a scoring system for LCN (SALAS score) in colorectal surgery and whether an adequate scoring can be achieved using a specified sequence of the operation.MethodsThe score was assessed by four blinded raters using synchronized video and voice recordings of 20 randomly selected laparoscopic colorectal surgeries (group A: assessment of the entire operation; group B: assessment of the 2nd and 3rd quartile). Experience in LCN was defined as at least 100 assistances in complex laparoscopic procedures.ResultsThe surgical teams consisted of three residents, three fellows, and two attendings forming 15 different teams. The ratio between experienced and inexperienced camera assistants was balanced (n = 11 vs. n = 9). Regarding the total SALAS score, the four raters discriminated between experienced and inexperienced camera assistants, regardless of their group assignment (group A, p < 0.05; group B, p < 0.05). The score’s interrater variability and reliability were proven with an intraclass correlation coefficient of 0.88. No statistically relevant correlation was achieved between operation time and SALAS score.ConclusionThis study presents the first intraoperative, objective, and structured assessment of LCN in colorectal surgery. We could demonstrate that the SALAS score is a reliable tool for the assessment of LCN even when only the middle part (50%) of the procedure is analyzed. Construct validity was proven by discriminating between experienced and inexperienced camera assistants.

Highlights

During laparoscopic surgery, camera navigation is often performed by less experienced members of the surgical team
With the structured assessment of laparoscopic camera navigation skills (SALAS) score, we developed the first objective intraoperative assessment tool for laparoscopic camera assistance [10]
The score was developed using a variety of laparoscopic procedures, construct validity has so far been proven for laparoscopic cholecystectomy, a basic laparoscopic operation

Summary

Introduction

Camera navigation is often performed by less experienced members of the surgical team. The limitations of minimally invasive surgery for depth perception, reduction of tactile feedback, and the fulcrum effect (the optical inversion of the movements on the screen) do not apply to the main surgeon only and to the (camera) assistant [1, 2]. With the structured assessment of laparoscopic camera navigation skills (SALAS) score, we developed the first objective intraoperative assessment tool for laparoscopic camera assistance [10]. Laparoscopic large bowel procedures qualify as advanced laparoscopic operations according to the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), suggesting advanced camera navigation as well [11].

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