Rachel Mathis1,2, Yusuke Watanabe3, Iman Ghaderi4, Dmitry Nepomnayshy5. 1. Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA. rachelhmathis@gmail.com. 2. , Lexington, KY, USA. rachelhmathis@gmail.com. 3. Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Sapporo, Japan. 4. Department of Surgery, University of Arizona, Tucson, AZ, USA. 5. Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA.
Abstract
BACKGROUND: As the field of laparoscopic surgery grows, the need for a valid assessment of laparoscopic surgical skills becomes apparent. The objective of this study was to identify laparoscopic suturing skills reflective of performing at an expert level. METHODS: A Delphi Study was conducted with expert laparoscopic surgeons. Tasks were considered to meet criteria for consensus after 80% of survey participants answered "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 three rounds, reaching 80% consensus on each skill, or if > 50% of initial respondents fail to return for subsequent surveys. RESULTS: After three rounds of surveys completed by 13 advanced laparoscopic surgeons, 8 observed skills met consensus (> 80% selected "strongly agree"): forehand suturing, continuous suturing, avoiding tissue trauma, achieving a technically acceptable final product (tight closure), tying a secure knot at the end of suturing, maintaining/checking for appropriate tightness of running suture, accurate depth perception, and loading the needle in < 3 attempts. Skills that approached consensus (with > 50% ranking them as "strongly agree") included correct penetration of target tissue, ability to create a surgeon's knot, awareness of needle tip position, confined space suturing, following the curve of the needle, smooth movements of instruments, loading the needle correctly, adjusting for tissue thickness, and bimanual dexterity. CONCLUSIONS: Using Delphi methodology, we identified the skills that are representative of expert laparoscopic suturing. This information can be used to create an assessment tool for this domain. Validation of such a tool will help advance the surgical field towards true competency-based assessment of expertise.
BACKGROUND: As the field of laparoscopic surgery grows, the need for a valid assessment of laparoscopic surgical skills becomes apparent. The objective of this study was to identify laparoscopic suturing skills reflective of performing at an expert level. METHODS: A Delphi Study was conducted with expert laparoscopic surgeons. Tasks were considered to meet criteria for consensus after 80% of survey participants answered "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 three rounds, reaching 80% consensus on each skill, or if > 50% of initial respondents fail to return for subsequent surveys. RESULTS: After three rounds of surveys completed by 13 advanced laparoscopic surgeons, 8 observed skills met consensus (> 80% selected "strongly agree"): forehand suturing, continuous suturing, avoiding tissue trauma, achieving a technically acceptable final product (tight closure), tying a secure knot at the end of suturing, maintaining/checking for appropriate tightness of running suture, accurate depth perception, and loading the needle in < 3 attempts. Skills that approached consensus (with > 50% ranking them as "strongly agree") included correct penetration of target tissue, ability to create a surgeon's knot, awareness of needle tip position, confined space suturing, following the curve of the needle, smooth movements of instruments, loading the needle correctly, adjusting for tissue thickness, and bimanual dexterity. CONCLUSIONS: Using Delphi methodology, we identified the skills that are representative of expert laparoscopic suturing. This information can be used to create an assessment tool for this domain. Validation of such a tool will help advance the surgical field towards true competency-based assessment of expertise.
Authors: Samer G Mattar; Adnan A Alseidi; Daniel B Jones; D Rohan Jeyarajah; Lee L Swanstrom; Ralph W Aye; Steven D Wexner; José M Martinez; Sharona B Ross; Michael M Awad; Morris E Franklin; Maurice E Arregui; Bruce D Schirmer; Rebecca M Minter Journal: Ann Surg Date: 2013-09 Impact factor: 12.969
Authors: Elif Bilgic; Yusuke Watanabe; Dmitry Nepomnayshy; Aimee Gardner; Shimae Fitzgibbons; Iman Ghaderi; Adnan Alseidi; Dimitrios Stefanidis; John Paige; Neal Seymour; Katherine M McKendy; Richard Birkett; James Whitledge; Erica Kane; Nicholas E Anton; Melina C Vassiliou Journal: Am J Surg Date: 2016-10-08 Impact factor: 2.565
Authors: Ivan R Diamond; Robert C Grant; Brian M Feldman; Paul B Pencharz; Simon C Ling; Aideen M Moore; Paul W Wales Journal: J Clin Epidemiol Date: 2014-04 Impact factor: 6.437