Video-based tools for surgical quality assessment of technical skills in laparoscopic procedures: a systematic review

Grüter, A.A.J.; Lieshout, Annabel S. van; Oostendorp, S. E. van; Henckens, Sofie; Ket, Hans; Gisbertz, Suzanne S.; Toorenvliet, Boudewijn R.; Tanis, Pieter J.; Bonjer, H. Jaap; Tuynman, Jurriaan B.

doi:10.1007/s00464-023-10076-z

Cited by 7 publications

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References 74 publications

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“…Assessing by automated generated metrics reduces the risks of errors in the response process, and virtual reality and the ProMIS simulator are examples of the use of automated generation of metrics (Figure 2). Artificial intelligence may play a role in assessing surgical competencies by enabling automatically generated scores from video assessment in the future [79,80].…”

Section: Discussionmentioning

confidence: 99%

Training and assessment for colorectal surgery and appendicectomy– a systematic review

Hertz,

Rattenborg,

Haug

et al. 2024

Colorectal Disease

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AimThere is currently an increased focus on competency‐based training, in which training and assessment play a crucial role. The aim of this systematic review is to create an overview of hands‐on training methods and assessment tools for appendectomy and colon and rectal surgery procedures using either an open, laparoscopic or robot‐assisted approach.MethodA systematic review of Medline, Embase, Cochrane and Scopus databases was conducted following the PRISMA guidelines. We conducted the last search on 9 March 2023. All published papers describing hands‐on training, evaluation of performance data and development of assessment tools were eligible. The quality of studies and the validity evidence of assessment tools are reported.ResultsFifty‐one studies were identified. Laparoscopic assessment tools are abundant, but the literature still lacks good‐quality assessment tools for open appendectomy, robotic colectomy and open rectal surgery. Overall, there is a lack of discussion regarding the establishment of pass/fail standards and the consequences of assessment. Virtual reality simulation is used more for appendectomy than colorectal procedures. Only a few of the studies investigating training were of acceptable quality. There is a need for high‐quality studies in open and robotic‐assisted colon surgery and all approaches to rectal surgery.ConclusionThis review provides an overview of current training methods and assessment tools and identifies where more research is needed based on the quality of the studies and the current validity evidence.

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Section: Discussionmentioning

confidence: 99%

Training and assessment for colorectal surgery and appendicectomy– a systematic review

Hertz,

Rattenborg,

Haug

et al. 2024

Colorectal Disease

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“…Standardization not only facilitates more efficient training, but can also result in optimized learning curves 13 . Furthermore, incorporation of a validated competency assessment tool (CAT) enables objective and quantifiable surgical quality assessment (SQA) with detailed feedback for individual surgeons, potentially leading to improved clinical outcomes 14 .…”

Section: Introductionmentioning

confidence: 99%

Nationwide standardization of minimally invasive right hemicolectomy for colon cancer and development and validation of a video-based competency assessment tool (the Right study)

Grüter,

Toorenvliet,

Belgers

et al. 2023

British Journal of Surgery

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Background Substantial variation exists when performing a minimally invasive right hemicolectomy (MIRH) due to disparities in training, expertise and differences in implementation of innovations. This study aimed to achieve national consensus on an optimal and standardized MIRH technique for colon cancer and to develop and validate a video-based competency assessment tool (CAT) for MIRH. Method Statements covering all elements of MIRH were formulated. Subsequently, the Delphi technique was used to reach consensus on a standardized MIRH among 76 colorectal surgeons from 43 different centres. A CAT was developed based on the Delphi results. Nine surgeons assessed the same 12 unedited full-length videos using the CAT, allowing evaluation of the intraclass correlation coefficient (ICC). Results After three Delphi rounds, consensus (≥80% agreement) was achieved on 23 of the 24 statements. Consensus statements included the use of low intra-abdominal pressure, detailed anatomical outline how to perform complete mesocolic excision with central vascular ligation, the creation of an intracorporeal anastomosis, and specimen extraction through a Pfannenstiel incision using a wound protector. The CAT included seven consecutive steps to measure competency of the MIRH and showed high consistency among surgeons with an overall ICC of 0.923. Conclusion Nationwide consensus on a standardized and optimized technique of MIRH was reached. The CAT developed showed excellent interrater reliability. These achievements are crucial steps to an ongoing nationwide quality improvement project (the Right study).

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Surgical quality assessment of critical view of safety in 283 laparoscopic cholecystectomy videos by surgical residents and surgeons

Grüter,

Daams,

Bonjer

et al. 2024

Surg Endosc

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Introduction Surgical quality assessment has improved the efficacy and efficiency of surgical training and has the potential to optimize the surgical learning curve. In laparoscopic cholecystectomy (LC), the critical view of safety (CVS) can be assessed with a 6-point competency assessment tool (CAT), a task commonly performed by experienced surgeons. The aim of this study is to determine the capability of surgical residents to perform this assessment. Methods Both surgeons and surgical residents assessed unedited LC videos using a 6-point CVS, a CAT, using an online video assessment platform. The CAT consists of the following three criteria: 1. clearance of hepatocystic triangle, 2. cystic plate, and 3. two structures connect to the gallbladder, with a maximum of 2 points available for each criterion. A higher score indicates superior surgical performance. The intraclass correlation coefficient (ICC) was employed to assess the inter-rater reliability between surgeons and surgical residents. Results In total, 283 LC videos were assessed by 19 surgeons and 31 surgical residents. The overall ICC for all criteria was 0.628. Specifically, the ICC scores were 0.504 for criterion 1, 0.639 for criterion 2, and 0.719 for the criterion involving the two structures connected to the gallbladder. Consequently, only the criterion regarding clearance of the hepatocystic triangle exhibited fair agreement, whereas the other two criteria, as well as the overall scores, demonstrated good agreement. In 71% of cases, both surgeons and surgical residents scored a total score either ranging from 0 to 4 or from 5 to 6. Conclusion Compared to the gold standard, i.e., the surgeons’ assessments, surgical residents are equally skilled at assessing critical view of safety (CVS) in laparoscopic cholecystectomy (LC) videos. By incorporating video-based assessments of surgical procedures into their training, residents could potentially enhance their learning pace, which may result in better clinical outcomes.

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Video-based tools for surgical quality assessment of technical skills in laparoscopic procedures: a systematic review

Cited by 7 publications

References 74 publications

Training and assessment for colorectal surgery and appendicectomy– a systematic review

Training and assessment for colorectal surgery and appendicectomy– a systematic review

Nationwide standardization of minimally invasive right hemicolectomy for colon cancer and development and validation of a video-based competency assessment tool (the Right study)

Surgical quality assessment of critical view of safety in 283 laparoscopic cholecystectomy videos by surgical residents and surgeons

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