Video-based skill assessment of endoscopic suturing in a pediatric chest model and a box trainer.

Abstract

Pediatric endoscopic surgery requires special surgical skills because of the small working space and tissue fragility. This article presents a video-based skill assessment method for endoscopic suturing using a pediatric chest model. A commercial suture pad was placed in a rapid-prototyped pediatric chest model of a 1-year-old patient to simulate the thoracoscopic repair of esophageal atresia type C. Twenty-eight pediatric surgeons (9 experts, 9 intermediates, and 10 trainees) performed an endoscopic intracorporeal suturing and knot-tying task both in the pediatric chest model and in a box trainer. The tasks were video-recorded and rated by two blinded observers using the 29-point checklist method and a suturing errors score sheet method. The task completion time and the number of needle manipulations were measured. The expert group showed better performance than the intermediate and trainee groups in the pediatric chest model, and the differences were larger than those in the box trainer. Significant differences between the expert and the trainee groups were observed in the items related to safety such as the skills for keeping the needle in view at all times. Significant differences between the expert and intermediate groups were observed in the items related to task quality and efficiency such as the smoothness of knot tying and the number of needle manipulations. Video-based skill assessment of endoscopic suturing using the pediatric chest model and a box trainer distinguished pediatric endoscopic surgeons according to their clinical experience, and pediatric-specific skills were identified.