The Fundamentals of Laparoscopic Suturing (FLS) “Illusion of Validity” in Laparoscopic Vaginal Cuff Suturing. Is There Anything Better?

Abstract

Study Objective The “illusion of validity” is a cognitive bias in which the ability to interpret and predict surgical performance accurately is overestimated. To address this cognitive bias, and to determine the most representative task for laparoscopic cuff suturing, we assessed participants on simulation tasks and in placement of the first suture in the vaginal cuff of a cadaver. Design Validity (Messick Framework) study comparing FLS and non-FLS tasks to cadaveric vaginal cuff suturing. Setting Simulation center cadaver lab. Patients or Participants Obstetrics and gynecology residents (n=21), fellows (n=3), gynecologic surgical subspecialists (n=4), general obstetrician/gynecologists (n=10). Interventions Tasks included a simulated vaginal cuff (ipsilateral port placement), needle passage through a metal eyelet loop (contralateral and ipsilateral), and intracorporeal knot tying (contralateral and ipsilateral). Times on these tasks were compared to the placement of the first cadaveric vaginal cuff suture time, as well as the in-person and blinded Global Operative Assessment of Laparoscopic Skills (GOALS) score (validity evidence). Statistical analyses included Spearman's test of correlation (continuous and ordinal variables) or Wilcoxon rank sum test (categorical variables). Measurements and Main Results A strong agreement between the in-person and blinded GOALS (ICC=0.80), and strong correlations of cadaver cuff time with in-person (Spearman's r:-0.84,P Conclusion Laparoscopic cadaveric vaginal cuff suturing performance was generally poor among residents and non-subspecialist gynecologists suggesting an “illusion of validity” in current surgical assessments. Since gynecology specific validity evidence has not been established for the FLS intracorporeal suturing task, we recommend prioritizing the use of a simulated-vaginal cuff suturing assessment instead of FLS.