Development and Validation of a Simulation Model for Laparoscopic Colpotomy

Abstract

OBJECTIVE: To develop a realistic simulation model for performance of laparoscopic colpotomy and evaluate its construct and face validity. METHODS: A simulation model was developed and constructed using polyvinyl chloride piping, a uterine manipulator, and synthetic vaginal tissue paired with a commercially available laparoscopic trainer. An observational study was conducted to validate the simulation model for use as a teaching tool. Construct validity was measured through performance evaluation of novice and expert surgeons using a standard and modified Global Operative Assessment of Laparoscopic Skills scale with possible score ranges of 5–25 and 5–40, respectively. Expert surgeons included attending surgeons across various gynecologic subspecialties who teach total laparoscopic hysterectomy to trainees and perform more than 50 total laparoscopic hysterectomies annually. Novice surgeons included residents who perform total laparoscopic hysterectomy as part of their training. Standards were set using a modified contrasting groups approach. Interrater reliability was calculated using Kendall’s τ correlation coefficient. Participants were surveyed regarding the realism of the model and its utility as a teaching tool to assess face validity. RESULTS: Five expert and 15 novice surgeons volunteered to participate. Expert surgeons scored higher than novice surgeons on the Global Operative Assessment of Laparoscopic Skills scale (22.8±1.52 vs 13.53±2.69, respectively) with a mean difference of 9.27 (95% CI 7.12–11.4, P<.01) and on a modified Global Operative Assessment of Laparoscopic Skills scale (36.9±2.19 vs 22.6±3.95, respectively) with a mean difference of 14.30 (95% CI 11.2–17.4, P<.01). Suggested passing range was set at 30.5–32.5 out of 40 total points. Kendall’s τ interrater reliability was 0.86 (95% CI 0.798–0.923) and 0.87 (95% CI 0.818–0.922), respectively. All participants agreed that the training model was useful for teaching and learning laparoscopic colpotomy and for assessing the learner’s ability to perform colpotomy before live surgery. CONCLUSION: This validated simulation system offers novice surgeons an opportunity to practice the skill set necessary to perform laparoscopic colpotomy efficiently and may be used as an educational tool.

Objective assessment tools in laparoscopic or robotic‐assisted gynecological surgery: A systematic review

“…A total of 10 out of 13 (79.6%) global tools reported relationships to other variables by either comparing novices to experts (construct validity) or showing significant correlation between scoring outcomes and other performance assessment tools, considered the gold standard (concurrent validity) 22–24,27,28,30,35,36,38–40,57,58,61–77 . Nine out of 13 (69.2%) procedure‐specific tool studies 31–33,42–44,46–50,60 showed construct or concurrent validity.…”

“…A total of 10 out of 13 (79.6%) global tools reported relationships to other variables by either comparing novices to experts (construct validity) or showing significant correlation between scoring outcomes and other performance assessment tools, considered the gold standard (concurrent validity). 22 , 23 , 24 , 27 , 28 , 30 , 35 , 36 , 38 , 39 , 40 , 57 , 58 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 Nine out of 13 (69.2%) procedure‐specific tool studies 31 , 32 , 33 , 42 , 43 , 44 , 46 , 47 , 48 , 49 , 50 , 60 showed construct or concurrent validity. Nine out of 11 (81.8%) APM showed construct or criterion validity.…”

“…outcomes and other performance assessment tools, considered the gold standard (concurrent validity). [22][23][24]27,28,30,35,36,[38][39][40]57,58,[61][62][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77] Nine out of 13 (69.2%) procedure-specific tool studies [31][32][33][42][43][44][46][47][48][49][50]60 showed construct or concurrent validity.…”

“…The most common reported form was inter-rater reliability with 10 out of 13 (76.9%) global rating tools and 10 out of 13 (76.9%) procedurespecific tools. All manual global tools report good to excellent inter-rater reliability, [23][24][25]30,33,35,[37][38][39][40]57,[61][62][63][64][65][66][67][68][69][70] with the exception of one modified OSATS in a dry laboratory setting for a simple laparoscopic ovarian cystectomy by Chahine et al 71 Inter-rater reliability among procedure-specific tools [31][32][33][42][43][44]46,47,59,60 showed good to excellent correlation except for specific domains for the H-OSATS and the dissection assessment for robotic technique. 43,60 Intrarater reliability was reported for 4/13 (30.8%) global tools demonstrating excellent intrarater reliability.…”

A review of simulation training and new 3D computer-generated synthetic organs for robotic surgery education

“…More advanced models have been developed in recent years. Realistic synthetic simulation models for gynaecological procedures have been cited as an effective tool in surgical training and assessment in both open [ 68 – 70 ] and laparoscopic [ 71 , 72 ] procedures. Validation of the use of synthetic models in training surgical complication management in gynaecology has also yielded very positive results.…”