STILUS Academic Research Group (SARG) Section of The Surgical Trainees Interested in Laparoscopic and Robotic Urological Surgery Group, London, United Kingdom.
J Endourol. 2011 Sep;25(9):1497-502. doi: 10.1089/end.2010.0659.
The current first-line recommended modality for nephrectomy is by the laparoscopic approach. This is one of the most frequent laparoscopic interventions conducted in urology. From a skills acquisition and delivery perspective in minimally invasive urologic surgery, there is a paucity of objective scoring systems for advanced laparoscopic urologic procedures. We developed a system of direct observation with structured criteria to evaluate the surgical conduction of laparoscopic nephrectomy (LN). We tested the application and preliminary validity of the scoring system.
Sixty cases of prerecorded LN performed in four teaching hospitals were each analyzed by four mentors. Each mentor scored each case based on a 100-point scoring systemthat comprised 20 key steps for LN (each step ranging 0 to 5). Steps included port placement and safety checks in addition to the actual case. In addition, a negative marking system based on a 50-point index scoring system was deployed such that technically unsound techniques were penalized. The sum of the two resulted in the final score. The final scores independently submitted for each recorded case were analyzed and compared. The system was then used to predict the experience of a surgeon for 10 pilot cases. The cases included a mix of five fellows and five experienced laparoscopic urologic surgeons. The cases were blinded to the independent assessors. A further 20 cases involving 10 cases performed by a trainee who sufficiently completed training (as deemed by the recent award of a certificate of specialist training in urology) vs one who is not ready were reviewed.
There was no significant difference in the scores submitted by each of the four mentors for each of the cases observed. There was a strong correlation between overall score and seniority/experience of the performing surgeon of each case; ie, it was able to predict whether an experienced surgeon or laparoscopic fellow performed the case. It was able to predict accurately between a trainee who sufficiently completed training vs one who is "not ready."
The scoring system was a reliable tool for assessing the performance of LN and accurately predicts the level of experience of the surgeon. This system could be a useful supplementary tool for assessing the baseline skill and progress of trainees.
目前，腹腔镜手术是肾切除术的一线推荐方法。这是泌尿科最常见的腹腔镜介入手术之一。从微创泌尿外科技能获取和交付的角度来看，对于高级腹腔镜泌尿外科手术，缺乏客观的评分系统。我们开发了一种使用直接观察和结构化标准来评估腹腔镜肾切除术（LN）手术的系统。我们测试了评分系统的应用和初步有效性。
在四所教学医院中，对 60 例预先录制的 LN 进行了分析，由四名导师分别对每例进行了分析。每位导师根据包含 20 个 LN 关键步骤（每个步骤的分值为 0 至 5）的 100 分评分系统对每个病例进行评分。步骤包括端口放置和安全检查，以及实际手术。此外，还部署了基于 50 分指数评分系统的负分系统，对技术上不健全的技术进行处罚。这两个分数的总和构成了最终得分。为每个记录病例独立提交的最终得分进行了分析和比较。然后，该系统用于预测 10 个试点病例中一名外科医生的经验。这些病例包括五名研究员和五名经验丰富的腹腔镜泌尿外科医生的混合病例。这些病例对独立评估者是盲目的。进一步回顾了 20 例病例，其中 10 例由一名受训者完成了足够的培训（根据最近获得的泌尿科专科培训证书来判断），而另一名则尚未准备好。
对每个观察到的病例，每位导师提交的分数之间没有显著差异。总体得分与每个病例的执行外科医生的资历/经验之间存在很强的相关性；即，它能够预测是经验丰富的外科医生还是腹腔镜研究员进行了手术。它能够准确预测完成培训的受训者与“尚未准备好”的受训者之间的差异。
评分系统是评估 LN 手术表现的可靠工具，并准确预测外科医生的经验水平。该系统可以成为评估学员基线技能和进步的有用辅助工具。
