Validating a Procedure-specific Rating Scale for Single Incision Laparoscopic Cholecystectomy

Richard M Kwasnicki, Trystan M Lewis, Sanjay Purkayastha, Rajesh Aggarwal, Alexandra Shepherd, Aimee N Di Marco, Ara Darzi, Paraskevas A Paraskeva. IMPERIAL COLLEGE LONDON


The prevalence of Single Incision Laparoscopic Surgery (SILS) in clinical practice is increasing.  However, there is currently a lack of validated assessment tools available to assess SILS operative performance.  This study aims to devise and validate a procedure-specific rating scale (PSRS) for SILS cholecystectomy, to facilitate objective technical skills assessment of SILS.

Methods and Materials
Ten medical students (NOV), and two experienced SILS surgeons (EXP) were recruited. All medical students initially completed a comprehensive cognitive module in laparoscopic surgery, gallbladder anatomy and SILS cholecystectomy technique described by an expert SILS surgeon.  All subjects performed two cadaveric porcine SILS cholecystectomies. A new PSRS was developed by two expert SILS surgeons using the cognitive task analysis technique.  Video assessment was carried out by two independent raters using the new PSRS and a modified Global Rating Scale (mGRS).

Construct validity was established with significant differences in performance demonstrated between the NOV and EXP group in all examined aspects of the new SILS cholecystectomy rating scale (median 9.25 vs. 23.5, P < 0.001).  The NOV group also had a significantly lower mGRS score than the EXP group (6 vs. 18.5, P < 0.001). Concurrent validity was established with a significant correlation demonstrated between PSRS and mGRS (inter-test correlation was 0.827).  The inter-rater reliability of the assessments was 0.911.

There are currently no methods for assessing technical performance in SILS.  This study has developed and validated a new PSRS, which can be used as an objective assessment tool for SILS cholecystectomy.  This tool could be used to assess the development of SILS technical skills as part of a structured SILS training curriculum.

Session Number: Poster – Poster Presentations
Program Number: P153
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