Intra-observer and inter-observer variability in scoring laparoscopic diagnosis of pelvic adhesions

Abstract

The objective of this study was to investigate intra-observer as well as inter-observer variability in the assessment of laparoscopic scoring of adhesive disease. Patients with suspected pelvic adhesions underwent a laparoscopic examination and surgical correction, using a standardized adhesion scoring system for severity as well as for extent of the adhesive process. An active agent or placebo was placed in the peritoneal cavity to discourage reformation of adhesions on a double-blind basis. A second laparoscopy was performed in 6-10 weeks and patients were re-scored. The videotapes were viewed and re-scored by the operator and four other gynaecological surgeons on two occasions, 3 months apart. Both adhesion severity and extent scores were lower following laparoscopic intervention. Reliability coefficients as defined by intra-class correlations were large indicating good reliability (0.778 and 0.758 for severity and extent respectively). Intra-observer (replication) variability was 12% of the total versus 19% for inter-observer variability of adhesion severity. These values were 15.4 and 22.3% of the total respectively, for adhesion extent. Individual observers tended to up-grade severity and minimize extent of adhesions when comparing the second with the first videotape views. The surgeon recorded greater adhesion score differences between the two procedures than the other observers. Though two physicians consistently had higher scores than two others, the intra-observer and interobserver variabilities were acceptable. Consultant review of high quality videotaped laparoscopic procedures is a valid method of independent assessment of operative findings.

Use of Modified Polysaccharide 4DryField®PH for Adhesion Prevention and Hemostasis in Gynecological Surgery: A Two-Center Observational Study by Second-Look Laparoscopy

“…Adhesions were assessed from both surgical reports and intraoperative video recordings and classified as 0 (no adhesions), I (minor filmy adhesions), and II (major adhesions), according to Corson et al [ 19 ].…”

Abdominal Adhesion Prevention: Still a Sticky Subject

“…Further assessment of adhesion strength is necessary, although this can be somewhat subjective. Studies have negated this problem to some degree by using video of procedures to allow an independent observer’s interpretation of adhesion strength to be compared with the operating surgeon [62,63,64]. Typically, the expression of adhesion density starts with filmy adhesions easily taken down by blunt dissection, progressing in density where sharp dissection is required and finally firmly adherent, where no discernable plane is evident.…”

Intraobserver and interobserver reliability of videotaped laparoscopy evaluations for endometriosis and adhesions

“…When comparing our findings with those of previous studies (1)(2)(3)(4)(5), it is important to realize that there are many differences in design, sample, and measurement. For example, in contrast to others, our aim was to evaluate the intra-and interobserver reliability of the videotaped evaluations, we used a heterogeneous population of women with endometriosis and/or adhesions or without disease, and our assessors were blinded for clinical information and one another's measurements.…”

“…Consecutive women from a gynecologic outpatient clinic of a university hospital for whom a diagnostic laparoscopy was indicated for [1] chronic pelvic pain (CPP), [2] sterilization, or [3] infertility workup (FER) were invited to participate in the study.…”

“…Gradually, videotaped laparoscopies found general acceptance for residential training, informing the patient of the findings, and requesting second opinions. Video recordings have also been introduced as evidence both for and against the operator in medical malpractice proceedings (1). In these circumstances, it is a prerequisite that evaluations of videotaped laparoscopies are consistent with real-time laparoscopic findings, the so-called "gold standard.…”