Construct Validity of a Training Model for Laparoscopic Heller Myotomy and Dor Fundoplication Using the Goals Score

Omar Bellorin, MD, Sharma Saurabh, MD, Alexander Ramirez-Valderrama, MD, Paul Lee, MD. New York Hospital Queens / Weill Cornell Medical College


The aim of this study is to determinate the capability of a training model for laparoscopic Heller-Dor Myotomy to discriminate between different levels of laparoscopic expertise (construct validity) using the GOALS scale.

Laparoscopic training demands practice so efficiency in the operating room can be achieved. Several training models have been developed to bridge the learning curve in different laparoscopic procedures. The transfer of laparoscopic skills from training models to real surgical procedures has been proven. We developed a low-cost model of laparoscopic Heller-Dor myotomy for advanced laparoscopic training. The global operative assessment of laparoscopic skills (GOALS) score is a 5-item global rating scale developed to evaluate intraoperative laparoscopic skills by direct observation. The five domains include depth perception, bimanual dexterity, efficiency, tissue handling and autonomy. This scale has been used to perform construct validity of several laparoscopic training models with reliable results


The performance of two groups with different levels of expertise in laparoscopy, novices (junior surgical residents <50 laparoscopic procedures) and experts (senior surgical residents > 200 laparoscopic procedures) were assessed. All participants were instructed to perform two tasks (esophageal myotomy and fundoplication) using a video tutorial. Novices received a hands-on session of intracorporeal knot tying prior evaluation on the training model. All the performances were recorded in a digital format. A laparoscopic expert who was blinded to subject’s identity evaluated the recordings using the valid and reliable GOALS scale. Autonomy, one of the 5 items of GOALS was removed since the evaluator and the trainee did not have interaction. The time required to finish each task was also recorded. Performance was compared using the Mann-Whitney U-test (p<.05 was significant).


Twenty subjects were evaluated, ten in each group, using the GOALS score. The time required finishing the two tasks was also assessed. The mean total GOALS score for novices was 7.5 points (SD: 1.64), and 13.9 points (SD: 1.66) for experts (p<.05). The expert group was superior in each domain of the GOALS score compared to novices: depth perception (mean: 3.3 vs 2 p<.05), bimanual dexterity (mean 3.4 vs 2.1 p<.05), efficiency (mean 3.4 vs 1.7 p<.05) and tissue handling (mean 3.6 vs 1.7 p<.05). With regards to time, experts were superior in task one (mean 9.7 vs 14.9 min p<.05) and task 2 (mean 24 vs 47.1 min p<.05) compared to novices.


Construct validity for the inanimate laparoscopic Heller-Dor Myotomy training model was demonstrated. Therefore, it is a useful tool in the development and evaluation of the resident and fellow in training. The model can be used as well by dedicated foregut surgeons to improve laparoscopic skills.

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