Rachel H Mathis, MD1, Yusuke Watanabe, MD, PhD2, Iman Ghaderi, MD, MSc3, Dmitry Nepomnayshy, MD1. 1Lahey Hospital and Medical Center, 2Teine Kejinakai Medical Center, Hokkaido University Graduate School of Medicine, 3University of Arizona College of Medicine
Introduction: As the field of laparoscopic surgery grows, the need for standard measures of complex laparoscopic surgical skills is apparent. Fundamentals of Laparoscopic Skills (FLS) testing is required to complete general surgery residency, but there is no standard metric to convey expertise in advanced laparoscopic procedures. In an effort to develop a standardized assessment of laparoscopic suturing expertise, a group of experts was surveyed using Delphi methodology to reach consensus on observed laparoscopic suturing skills reflective of performing at an expert level.
Methods: Expert laparoscopic surgeons participated in serial surveys via REDCap (Research Electronic Data Capture). Experts included surgeons who perform >25/year laparoscopic procedures that involve intra-corporeal suturing, obtained from the authors’ personal and professions networks. Using a 5 point Likert scale, participants were asked to agree/disagree if 30 different observed laparoscopic suturing skills indicate performing at an expert level. These skills were chosen from prior assessment instruments in the literature and the authors’ previously published work. Tasks were considered to meet criteria for consensus and eliminated from the next round of the survey after reaching 80% consensus as “strongly agree.” Results of the previous round of surveys were shared with participants at the start of the next round. The predefined endpoint for the Delphi was set as maximum of 4 rounds, reaching 80% consensus on each skill, or if >50% of initial respondents fail to return for subsequent surveys.
Results: After the first round of the Delphi survey, 17 respondents met inclusion criteria. Preliminary data demonstrated 4 skills that reached consensus (>80% of respondents chose “strongly agree”): forehand suturing, avoiding tissue trauma, having a technically acceptable final product (ie. tight closure), and tying a secure knot at the end of suturing. 4 items did not approach consensus (<80% of respondents chose “strongly agree” or “agree”): alternating hands for each throw while tying, never missing a target when grabbing needle/suture, alternating direction of throws when tying, and backhand suturing. Data from all four rounds of surveys as well as the final draft of the assessment instrument will be available at time of presentation.
Conclusion: Preliminary data of this Delphi study allowed us to reach consensus amongst a group of expert laparoscopic surgeons on the characteristics of expert laparoscopic suturing, which will allow creation of a comprehensive assessment tool for this domain. Validation of such a tool will help advance the surgical field towards true competency- based credentialing and promotion.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87805
Program Number: P338
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster