Validity evidence for novel advanced laparoscopic suturing tasks

Yusuke Watanabe, MD, Katherine M McKendy, MD, Elif Bilgic, Ghada Enani, MBBS, Amin Madani, MD, Amani Munshi, MD, Liane S Feldman, MD, Gerald M Fried, MD, Melina C Vassiliou, MD. Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University


Current simulations for practicing laparoscopic suturing do not reflect the complexity of the skills required in the operating room. The purpose of this study was to develop 3 novel advanced suturing tasks and metrics, and to collect validity evidence for them as measures of suturing skill.


We developed 3 tasks based on training gaps identified through a previous needs assessment: needle handling (NH, Figure 1a), suturing under tension (UT, Figure 1b), and continuous suturing (CS, Figure 1c). Minimally invasive surgeons (MIS) and surgical residents (SR: PGY3-5) completed these tasks and a questionnaire regarding their educational value. Performance was assessed by 2 raters based on time and accuracy. Validity was assessed by comparing performance between the MIS group and SR group, and by correlating performance of all participants with self-reported laparoscopic suturing experience (50+ cases vs. <50 cases) using the Wilcoxon signed-rank test. The inter-rater reliability of the tasks was calculated using intraclass correlation coefficients. Internal consistency was assessed using Cronbach’s alpha. Data are expressed as median [25th percentile; 75th percentile].


Thirty-one subjects (13 MIS, 18 SR) were enrolled in the study (mean age 34; 77% male). Compared to the SR group, the MIS group had greater scores on all tasks (NH: 404 [353;474] vs. 349 [258;434], p=0.04; UT: 535 [369;627] vs. 246 [109;440], p<0.01; and CS: 820 [669;886] vs. 282 [83;507], p<0.01). Amongst all participants, laparoscopic suturing experience with 50+ cases was associated with significantly higher scores on all tasks (NH: 416 [382;482] vs. 347 [263;431], p= 0.02; UT: 537 [372;628] vs. 259 [145;414], p<0.01; and CS: 840 [715;887] vs. 285 [110;526], p<0.01). While all MIS surgeons completed the 3 tasks within the allotted time, 6 (33%) residents could not complete at least one out of the 3 tasks. Inter-rater reliability for all tasks was 0.99 and internal consistency was 0.80. The majority of participants agreed or strongly agreed that the tasks were relevant to practice, helped improve technical competence, and adequately measured suturing ability.


This study provides validity evidence for 3 novel advanced laparoscopic suturing tasks. Performance on all tasks correlated significantly with training level and self-reported experience. Integrating these tasks into educational curricula may help improve residents’ suturing skills and better prepare residents for the operating room.

Figure 1 Three novel advanced laparoscopic suturing tasks: a) needle handling (NH), b) suturing under tension (UT), and c) continuous suturing (CS)


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