Development and Evaluation of a Laparoscopic Common Bile Duct Exploration Simulator and Procedural Rating Scale

Byron F Santos, MD, Eric S Hungness, MD, Taylor J Reif, BS, Alexander P Nagle, MD, Deborah M Rooney, PhD, Nathaniel J Soper, MD. Northwestern University Department of Surgery


Introduction: Laparoscopic common bile duct exploration (LCBDE) is an effective, single-stage treatment for choledocholithiasis. However, LCBDE requires specific cognitive and technical skills, is infrequently performed by residents, and currently lacks suitable training and assessment modalities outside of the operating room. To address this gap in training, a simulator model for transcystic and transcholedochal LCBDE was developed and evaluated.

Methods: A procedure algorithm incorporating essential cognitive and technical steps of LCBDE was developed. A physical model was then built which allowed performance of a simulated LCBDE. To assess performance on the model, modified Objective Structured Assessment of Technical Skills (OSATS) rating scales were developed. Construct validity was assessed by comparing the performance of novices (residents and surgeons without LCBDE experience) versus experienced subjects (surgeons with previous LCBDE experience). Concurrent validity was assessed by comparing scores from the LCBDE scales to those from the standard OSATS scale. Internal consistency and inter-rater reliability were assessed by comparing performance scores assigned by three independent raters.

Results: Sixteen novices and five experienced subjects performed simulated procedures on the model. Novices scored lower than experienced subjects on both the transcystic (20 ± 3 v. 33 ± 2, [possible score range 0-45] p < .001) and transcholedochal (25 ± 8 v. 42 ± 3, [possible score range 0-53], p < .001) rating scales. Scores on the LCBDE rating scales showed significant correlation with scores from the standard OSATS scale. Internal consistency and inter-rater reliability of the transcystic and transcholedochal rating scales were favorable.

Conclusions: The LCBDE simulator described herein is a low-cost yet realistic physical model allowing performance and evaluation of technical skills required to perform LCBDE. The LCBDE rating scales show evidence of construct validity, concurrent validity, internal consistency, and inter-rater reliability when used to rate performance on the LCBDE simulator. Use of the LCBDE model and associated rating scales allows procedure-specific feedback for trainees and could be used to improve current training in LCBDE.

Session Number: SS13 – Simulation
Program Number: S073

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