Construct Validity Testing of a Laparoscopic Surgical Simulator

McDougall, Elspeth M.; Corica, Federico A.; Boker, John R.; Sala, L; Stoliar, Gabriela; Borin, James F.; Chu, Francis; Clayman, Ralph V.

doi:10.1016/j.jamcollsurg.2006.01.004

Cited by 139 publications

(74 citation statements)

References 10 publications

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“…40,43 In view of these barriers, several mentored and simulator-based training programs consequently emerged to facilitate skill transfer from experienced to laparoscopy-naive urologists. [44][45][46] The high percentage of provider-attributable variance also may reflect unmeasured differences in practice setting (and consequent access to information) among surgeons in our sample. That is, most providers make conclusive decisions about innovations based on interactions with local peer adopters rather than on scientific research or mass-media channels.…”

Section: Discussionmentioning

confidence: 96%

Diffusion of surgical innovation among patients with kidney cancer

Miller

Saigal

Banerjee

et al. 2008

Cancer

107

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BACKGROUNDDespite their potential benefits to patients with kidney cancer, the adoption of partial nephrectomy and laparoscopy has been gradual and asymmetric. To clarify whether this trend reflects differences in kidney cancer patients or differences in surgeon practice styles, the authors compared the magnitude of surgeon‐attributable variance in the use of partial nephrectomy and laparoscopic radical nephrectomy with that attributable to patient and tumor characteristics.METHODSBy using linked Surveillance, Epidemiology, and End Results‐Medicare data, the authors identified a cohort of 5483 Medicare beneficiaries who underwent surgery for kidney cancer between 1997 and 2002. Two primary outcomes were defined: 1) the use of partial nephrectomy and (2) the use of laparoscopy among patients undergoing radical nephrectomy. By using multilevel models, surgeon‐ and patient‐level contributions to observed variations in the use of partial nephrectomy and laparoscopic radical nephrectomy were estimated.RESULTSOf the 5483 cases identified, 611 (11.1%) underwent partial nephrectomy (43 performed laparoscopically), and 4872 (88.9%) underwent radical nephrectomy (515 performed laparoscopically). After adjusting for patient demographics, comorbidity, tumor size, and surgeon volume, the surgeon‐attributable variance was 18.1% for partial nephrectomy and 37.4% for laparoscopy. For both outcomes, the percentage of total variance attributable to surgeon factors was consistently higher than that attributable to patient characteristics.CONCLUSIONSFor many patients with kidney cancer, the surgery provided depends more on their surgeon's practice style than on the characteristics of the patient and his or her disease. Consequently, dismantling barriers to surgeon adoption of partial nephrectomy and laparoscopy is an important step toward improving the quality of care for patients with early‐stage kidney cancer. Cancer 2008. © 2008 American Cancer Society.

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Section: Discussionmentioning

confidence: 96%

Diffusion of surgical innovation among patients with kidney cancer

Miller

Saigal

Banerjee

et al. 2008

Cancer

107

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“…37 This concern has been recognized by both the urology and surgery communities, and, in recent years, several mentored and simulator-based programs have been developed to facilitate and enhance training in laparoscopy. 38,39 Nonetheless, despite the existence of recommended paradigms for laparoscopic training and credentialing since the early 1990s, training in laparoscopy still relies heavily on preceptorship and self-regulation rather than any formal certification process while credentialing varies by hospitals and generally involves limited regulatory oversight. [40][41][42] Similar challenges are now being recognized during the adoption of the robotic platform in surgical oncology.…”

Section: Discussionmentioning

confidence: 99%

Population‐level comparative effectiveness of laparoscopic versus open radical nephrectomy for patients with kidney cancer

Tan

Wolf

et al. 2011

Cancer

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BACKGROUND:Because there is limited population-based evidence supporting the comparative effectiveness of laparoscopic radical nephrectomy (LRN) after its widespread adoption, we compared trends in hospital-based outcomes among patients with kidney cancer treated with LRN or open radical nephrectomy (ORN). METHODS: Using linked SEER-Medicare data, the authors identified patients with kidney cancer who were treated with LRN or ORN from 2000 through 2005. The authors measured 4 primary outcomes: intensive care unit (ICU) admission, prolonged length of stay, 30-day hospital readmission, and in-hospital mortality. The authors then estimated the association between surgical approach and each outcome, adjusting for patient demographics, tumor characteristics, and year of surgery. RESULTS: The authors identified 2108 (26%) and 5895 (74%) patients treated with LRN and ORN, respectively. Patients treated with LRN were more likely to be white, female, of higher socioeconomic position, and to have tumor sizes of 4 cm (all P < .05). The adjusted probability of ICU admission and prolonged length of stay was 41% and 46% lower, respectively, for patients undergoing LRN (P < .001). Although uncommon for both groups, the adjusted probability of in-hospital mortality was 51% higher (2.3% vs 1.5%, P ¼ .04) for patients treated with a laparoscopic approach. CONCLUSIONS: At a population level, patients treated with LRN have a lower likelihood of ICU admission and prolonged length of stay, supporting the convalescence benefits of laparoscopy. In-hospital mortality, however, was higher among patients treated with LRN. The latter finding suggests a potentially unanticipated consequence of this technique and highlights the need for long-term monitoring during and after the widespread adoption of new surgical technologies. Cancer 2011;117:4184-93.

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“…7 We could not distinguish, however, the high-volume experienced physicians and the low-volume experienced physicians in any of the parameters of LapMentor. One reason for this discrepancy could be that in the study by McDougall and colleagues, 7 the performances by physicians in a task were determined by the manufacturer's predetermined skill task scores, which were automatically calculated by the machine software. In contrast, in our study, this built-in scoring calculation could not be used because of the difference of the software; thus, each set of motion analysis data was compared among the groups in our study.…”

Section: Discussionmentioning

confidence: 85%

“…In SKs 7 and 8, experienced physicians with > 30 laparoscopic surgeries/year showed significantly better results than physicians with < 30 laparoscopic surgeries/year. McDougall and associates 7 concluded that SK8 afforded the greatest distinction of surgical experience because of its degree of complexity.…”

Section: Discussionmentioning

confidence: 99%

Positive Correlation Between Motion Analysis Data on the Lapmentor™ Virtual Reality Laparoscopic Surgical Simulator and the Results From Video Tape Assessment of Real Laparoscopic Surgeries

Matsuda¹,

Ono²,

Baba³

et al. 2008

Journal of Urology

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Purpose: We studied the construct validity of the LapMentor, a virtual reality laparoscopic surgical simulator, and the correlation between the data collected on the LapMentor and the results of video assessment of real laparoscopic surgeries. Materials and Methods: Ninety-two urologists were tested on basic skill tasks No. 3 (SK3) to No. 8 (SK8) on the LapMentor. They were divided into three groups: Group A (n = 25) had no experience with laparoscopic surgeries as a chief surgeon; group B (n = 33) had < 35 experiences; and group C (n = 34) had ‡ 35 experiences. Group scores on the accuracy, efficacy, and time of the tasks were compared. Forty physicians with ‡ 20 experiences supplied unedited videotapes showing a laparoscopic nephrectomy or an adrenalectomy in its entirety, and the videos were assessed in a blinded fashion by expert referees. Correlations between the videotape score (VS) and the performances on the LapMentor were analyzed. Results: Group C showed significantly better outcomes than group A in the accuracy (SK5) (P = 0.013), efficacy (SK8) (P = 0.014), or speed (SKs 3 and 8) (P = 0.009 and P = 0.002, respectively) of the performances of LapMentor. Group B showed significantly better outcomes than group A in the speed and efficacy of the performances in SK8 (P = 0.011 and P = 0.029, respectively). Analyses of motion analysis data of LapMentor demonstrated that smooth and ideal movement of instruments is more important than speed of the movement of instruments to achieve accurate performances in each task. Multiple linear regression analysis indicated that the average score of the accuracy in SK4, 5, and 8 had significant positive correlation with VS (P = 0.01). Conclusions: This study demonstrated the construct and predictive validity of the LapMentor basic skill tasks, supporting their possible usefulness for the preclinical evaluation of laparoscopic skills.

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Construct Validity Testing of a Laparoscopic Surgical Simulator

Cited by 139 publications

References 10 publications

Diffusion of surgical innovation among patients with kidney cancer

Diffusion of surgical innovation among patients with kidney cancer

Population‐level comparative effectiveness of laparoscopic versus open radical nephrectomy for patients with kidney cancer

Positive Correlation Between Motion Analysis Data on the Lapmentor™ Virtual Reality Laparoscopic Surgical Simulator and the Results From Video Tape Assessment of Real Laparoscopic Surgeries

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