University of Toronto, 600 University Ave, Rm. 440, Toronto, ON, M5G 1X5, Canada.
Surg Endosc. 2012 Sep;26(9):2489-503. doi: 10.1007/s00464-012-2220-9. Epub 2012 Apr 5.
Laparoscopic colorectal surgery is considered an advanced minimally invasive procedure with a long, variable learning curve. Developing an evaluation tool is essential to ensure that individuals reach a certain level of competence prior to performing this procedure independently. To achieve standardization and wide implementation, an assessment tool must be reflective of practice across many institutions.
The purpose of this study is to validate two procedure-specific evaluation tools for laparoscopic colorectal surgery that were developed using innovative consensus methodology. Two procedure-specific rating scales for laparoscopic right and sigmoid colectomy were created using the Delphi method. Nine novice and nine expert laparoscopic sigmoid colectomy videos were prospectively collected, and nine novice and ten expert laparoscopic right colectomy videos were recorded. The experts rated the videos using the procedure-specific technical skills evaluation tool for either laparoscopic right colectomy or laparoscopic sigmoid colectomy.
There were statistically significant differences between the expert and novice scores on the laparoscopic right colectomy evaluation tool: the median score of novices was 63.8% and the expert score was 73.1% (p = 0.02). Similarly, there was a significant difference between the median novice score on the sigmoid tool (58.6%) compared with the median expert score (70.7%) (p = 0.003). Cronbach's alpha was 0.82 for the right colectomy evaluation tool and 0.79 for the sigmoid rating scale.
The procedure-specific evaluation tools for laparoscopic right and sigmoid colectomy demonstrate strong reliability and construct validity, and have the potential to be used for technical skills assessment and feedback.
腹腔镜结直肠手术被认为是一种先进的微创手术，具有较长且可变的学习曲线。开发评估工具对于确保个人在独立执行该手术之前达到一定的能力水平至关重要。为了实现标准化和广泛实施，评估工具必须反映许多机构的实践情况。
本研究的目的是验证两种使用创新共识方法开发的腹腔镜结直肠手术专用评估工具。使用 Delphi 方法创建了两种用于腹腔镜右半结肠切除术和乙状结肠切除术的特定手术评分量表。前瞻性收集了 9 个新手和 9 个专家腹腔镜乙状结肠切除术视频，以及 9 个新手和 10 个专家腹腔镜右半结肠切除术视频。专家使用特定于手术的腹腔镜右半结肠切除术或腹腔镜乙状结肠切除术的技术技能评估工具对视频进行评分。
在腹腔镜右半结肠切除术评估工具上，专家和新手的评分存在统计学显著差异：新手的中位数评分为 63.8%，专家的评分为 73.1%（p=0.02）。同样，在乙状结肠工具上，新手的中位数评分（58.6%）与专家的中位数评分（70.7%）之间存在显著差异（p=0.003）。右半结肠切除术评估工具的 Cronbach's alpha 为 0.82，乙状结肠评分量表的 Cronbach's alpha 为 0.79。
腹腔镜右半结肠和乙状结肠切除术的特定手术评估工具具有很强的可靠性和结构有效性，并且有可能用于技术技能评估和反馈。
