Development of the Surgical Assistance Score (SAS)

Susannah M Wyles, MD, PhD1, Edward Kim, MD1, Eric Haas2, Nabil Tariq3, Bidhan B Das4, Michael Snyder4, Brian J Dunkin3. 1UCSF, 2Colorectal Surgical Associates, 3Houston Methodist Hospital, 4Colon and Rectal Clinic of Houston


It is widely acknowledged that prior to being a good surgeon it is necessary to learn the skills of surgical assistance, and that the degree of difficulty of an operation can be largely dependent on the ability of the assistant. The aim of this study was to determine the necessary assistance skills and to develop an assessment tool that could be used to map trainees’ progress, and also to guide feedback on their performance.

Methods and Procedures

A survey regarding operative assistance was distributed electronically to the surgical department at a large US teaching institution. Free text boxed allowed for open suggestions of desirable qualities in a surgical assistant. These items were collated, and using the Delphi process, lists were sent to expert laparoscopic and general surgeons from multiple institutions. The perceived importance of each item was ranked using a 5-point Likert scale. Items scoring less than 3 were removed. Repeat lists were sent until consensus was reached.


84 surveys were completed over a 4 week period (69% response rate), by a range of attendings and residents. 206 items were suggested as requirements for surgical assistance. On review by two researchers, these were reduced to 25 due to repetition or overlap of meaning. 5 experts rated the items, and reached consensus after 2 rounds of the Delphi process. After the first round, two new items were introduced, five items were summarized to one, one was reworded then accepted and one was rejected. A 22 item assessment form was then created. Requirements were grouped into “surgeon focused”, “knowledge”, “skills”, “operative view”, “safety” and “learning points”. There was also a free text box at the end of the assessment for further comments.


A novel tool has been developed to assess surgical assistance. The next steps would be to pilot the tool to assess its acceptability, feasibility and validity.

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