Evaluation of Surgical Performance During Laparoscopic Incisional Hernia Repair- A Multicenter Study

Introduction: Laparoscopic incisional hernia repair (LIHR) is a relatively common procedure yet requires advanced laparoscopic skills. There is no reliable or valid measure of performance during this procedure. The aim of this study was to develop a procedure-specific objective rating scale to assess performance of LIHR, and to evaluate its reliability and validity. Methods: The Global Operative Assessment of Laparoscopic Skills-Incisional Hernia Module (GOALS-IH) is a global rating scale developed by content experts consisting of 7 items evaluating the critical steps of LIHR (placement of trocars, adhesiolysis, estimation of size and shape of the mesh, introduction, orientation and positioning of the mesh, fixation of the mesh, knowledge and autonomy in the use of instruments, overall competence) each rated on a 5-point Likert scale (maximum possible score =35). During LIHR, 10 experienced and 12 intermediate level surgeons (PGY3 to 5) were evaluated at 4 University hospital centers by the attending, a trained observer and by self-assessment using the GOALS-IH, and by a previously validated 5-item general laparoscopic rating scale (GOALS). Interrater reliability was assessed by intraclass correlation (ICC), internal consistency of rating items by Cronbach’s alpha. Known-groups construct validity was assessed by t-test and by correlating the number of self-reported LIHR cases with total score; concurrent validity by correlating the procedure-specific rating scale with the GOALS general rating scale. Data are shown as mean (95% CI). Results: Interrater reliability for the total GOALS-IH score was 0.80 (0.56-0.92) between observer and attendings, 0.81 (0.58-0.92) between participants and attendings, and 0.89 (0.76-0.96) between participants and observer. Internal consistency was high, with Cronbach’s alpha 0.97. The correlation of each domain with total score ranged from 0.83 to 0.93. There was strong correlation between GOALS-IH and generic GOALS total scores (r =0.90, p<0.01). Experienced surgeons performed significantly better than intermediate surgeons when assessed by GOALS-IH (30.7 (27.5-33.8) vs 19.3 (17.1-21.5), p<0.01) and by general GOALS (22.4 (20.1-25) vs 15.6(13.6-17.7), p<0.01). There was also very good correlation between GOALS-IH and previous LIHR experience (r=0.82, p<0.01). Conclusion: This study shows that surgical performance during clinical LIHR can be assessed reliably using a procedure-specific global rating scale. Results can be used to provide formative feedback to the surgeon, and to identify steps of the operation that would benefit from specific educational interventions.

Session: Podium Presentation

Program Number: S034

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