An evaluation of the feasibility, validity, and reliability of laparoscopic skills assessment in the operating room
An evaluation of the feasibility, validity, and reliability of laparoscopic skills assessment in the operating room
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DOI：
10.1097/01.sla.0000262780.17950.e5
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发表时间：
2007-06-01
影响因子：
9
通讯作者：
Darzi, Ara
中科院分区：
文献类型：
--
作者：
Aggarwal, Rajesh;Grantcharov, Teodor;Darzi, Ara
目的：评估同步视频运动跟踪装置在手术室对腹腔镜技术进行客观、即时和自动评估的应用。背景资料：技术技能的评估是识别熟练外科实践的基础。有必要证明任何工具的有效性、可靠性和可行性，以用于客观衡量绩效。方法：19例受试者，分为13例经验丰富（手术次数为100次）和6例经验不足（手术次数小于10次）的外科医生，对53例诊断为胆道绞痛的患者完成腹腔镜胆囊切除术。每次手术都用基于视频的ROVIMAS运动跟踪设备进行记录，以提供外科医生灵巧度的客观测量。每个视频还由2名经验丰富的观察员根据先前验证的操作评估量表进行评分。结果：两组术者在Calot三角解剖部分运动跟踪参数上的时间（P = 0.002）、总路径长度（P = 0.026）、运动次数（P = 0.005）均有显著差异。运动跟踪和视频评估均表现出兴趣信度，两种评估模式之间存在较好的相关性（r = 0.4 ~ 0.7, P < 0.01）。结论：定义了一种即时、客观、有效和可靠的手术室腹腔镜效果评估模式。这可能有助于减少技术技能评估所花费的时间，并随后导致准确和有效的审计和资格认证的外科医生独立执业。
Objective: To assess the use of a synchronized video-based motion tracking device for objective, instant, and automated assessment of laparoscopic skill in the operating room.Summary Background Data: The assessment of technical skills is fundamental to recognition of proficient surgical practice. It is necessary to demonstrate the validity, reliability, and feasibility of any tool to be applied for objective measurement of performance.Methods: Nineteen subjects, divided into 13 experienced (performed > 100 laparoscopic cholecystectomies) and 6 inexperienced (performed < 10 LCs) surgeons completed LCs on 53 patients who all had a diagnosis of biliary colic. Each procedure was recorded with the ROVIMAS video-based motion tracking device to provide an objective measure of the surgeon's dexterity. Each video was also rated by 2 experienced observers on a previously validated operative assessment scale.Results: There were significant differences for motion tracking parameters between the 2 groups of surgeons for the Calot triangle dissection part of procedure for time taken (P = 0.002), total path length (P = 0.026), and number of movements (P = 0.005). Both motion tracking and video-based assessment displayed intertest reliability, and there were good correlations between the 2 modes of assessment (r = 0.4 to 0.7, P < 0.01).Conclusions: An instant, objective, valid, and reliable mode of assessment of laparoscopic performance in the operating room has been defined. This may serve to reduce the time taken for technical skills assessment, and subsequently lead to accurate and efficient audit and credentialing of surgeons for independent practice.