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. 2020 Jul;34(7):2947-2953.
doi: 10.1007/s00464-019-07077-2. Epub 2019 Aug 26.

Competency assessment tool for laparoscopic suturing: development and reliability evaluation

Wouter M IJgosse  1   2 , Erik Leijte  3 , Sandeep Ganni  4   5   6 , Jan-Maarten Luursema  3 , Nader K Francis  7 , Jack J Jakimowicz  4   5 , Sanne M B I Botden  8
Affiliations

Competency assessment tool for laparoscopic suturing: development and reliability evaluation

Wouter M IJgosse et al. Surg Endosc. 2020 Jul.

Abstract

Background: Laparoscopic suturing can be technically challenging and requires extensive training to achieve competency. To date no specific and objective assessment method for laparoscopic suturing and knot tying is available that can guide training and monitor performance in these complex surgical skills. In this study we aimed to develop a laparoscopic suturing competency assessment tool (LS-CAT) and assess its inter-observer reliability.

Methods: We developed a bespoke CAT tool for laparoscopic suturing through a structured, mixed methodology approach, overseen by a steering committee with experience in developing surgical assessment tools. A wide Delphi consultation with over twelve experts in laparoscopic surgery guided the development stages of the tool. Following, subjects with different levels of laparoscopic expertise were included to evaluate this tool, using a simulated laparoscopic suturing task which involved placing of two surgical knots. A research assistant video recorded and anonymised each performance. Two blinded expert surgeons assessed the anonymised videos using the developed LS-CAT. The LS-CAT scores of the two experts were compared to assess the inter-observer reliability. Lastly, we compared the subjects' LS-CAT performance scores at the beginning and end of their learning curve.

Results: This study evaluated a novel LS-CAT performance tool, comprising of four tasks. Thirty-six complete videos were analysed and evaluated with the LS-CAT, of which the scores demonstrated excellent inter-observer reliability. Cohen's Kappa analysis revealed good to excellent levels of agreement for almost all tasks of both instrument handling and tissue handling (0.87; 0.77; 0.75; 0.86; 0.85, all with p < 0.001). Subjects performed significantly better at the end of their learning curve compared to their first attempt for all LS-CAT items (all with p < 0.001).

Conclusions: We developed the LS-CAT, which is a laparoscopic suturing grading matrix, with excellent inter-rater reliability and to discriminate between experience levels. This LS-CAT has a potential for wider use to objectively assess laparoscopic suturing skills.

Keywords: Evaluation; Laparoscopic suturing; Objective assessment; Simulation; Training.

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Conflict of interest statement

W. M. IJgosse, E. Leijte, S. Ganni, N. K. Francis, J.-M. Luursema, J. J. Jakimowicz and S. M. B. I. Botden have no conflicts of interest or financial ties with eoSurgical Ltd. to disclose. There was no financial support for this study.

Figures

Fig. 1
Fig. 1
The eoSim-augmented reality laparoscopic simulator interface
Fig. 2
Fig. 2
The CAT form for laparoscopic suturing
See this image and copyright information in PMC

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