Knight Sophie, Aggarwal Rajesh, Agostini Aubert, Loundou Anderson, Berdah Stéphane, Crochet Patrice
Department of Obstetrics and Gynecology, Assistance Publique-Hôpitaux de Marseille, La Conception Hospital, Marseille, Aix Marseille Université, France.
Department of Surgery, Thomas Jefferson University,Philadelphia, Pennsylvania, United States of America.
PLoS One. 2018 Jan 2;13(1):e0190580. doi: 10.1371/journal.pone.0190580. eCollection 2018.
Total Laparoscopic hysterectomy (LH) requires an advanced level of operative skills and training. The aim of this study was to develop an objective scale specific for the assessment of technical skills for LH (H-OSATS) and to demonstrate feasibility of use and validity in a virtual reality setting.
The scale was developed using a hierarchical task analysis and a panel of international experts. A Delphi method obtained consensus among experts on relevant steps that should be included into the H-OSATS scale for assessment of operative performances. Feasibility of use and validity of the scale were evaluated by reviewing video recordings of LH performed on a virtual reality laparoscopic simulator. Three groups of operators of different levels of experience were assessed in a Marseille teaching hospital (10 novices, 8 intermediates and 8 experienced surgeons). Correlations with scores obtained using a recognised generic global rating tool (OSATS) were calculated.
A total of 76 discrete steps were identified by the hierarchical task analysis. 14 experts completed the two rounds of the Delphi questionnaire. 64 steps reached consensus and were integrated in the scale. During the validation process, median time to rate each video recording was 25 minutes. There was a significant difference between the novice, intermediate and experienced group for total H-OSATS scores (133, 155.9 and 178.25 respectively; p = 0.002). H-OSATS scale demonstrated high inter-rater reliability (intraclass correlation coefficient [ICC] = 0.930; p<0.001) and test retest reliability (ICC = 0.877; p<0.001). High correlations were found between total H-OSATS scores and OSATS scores (rho = 0.928; p<0.001).
The H-OSATS scale displayed evidence of validity for assessment of technical performances for LH performed on a virtual reality simulator. The implementation of this scale is expected to facilitate deliberate practice. Next steps should focus on evaluating the validity of the scale in the operating room.
全腹腔镜子宫切除术（LH）需要高水平的手术技能和培训。本研究的目的是开发一种专门用于评估LH技术技能的客观量表（H-OSATS），并证明其在虚拟现实环境中的使用可行性和有效性。
该量表采用层次任务分析法和国际专家小组开发。通过德尔菲法，专家们就应纳入H-OSATS量表以评估手术操作表现的相关步骤达成了共识。通过回顾在虚拟现实腹腔镜模拟器上进行的LH视频记录，评估该量表的使用可行性和有效性。在马赛一家教学医院对三组不同经验水平的操作人员进行了评估（10名新手、8名中级人员和8名经验丰富的外科医生）。计算了与使用公认的通用整体评分工具（OSATS）获得的分数之间的相关性。
层次任务分析共确定了76个离散步骤。14名专家完成了两轮德尔菲问卷。64个步骤达成共识并纳入量表。在验证过程中，对每个视频记录评分的中位时间为25分钟。新手组、中级组和经验丰富组的H-OSATS总分存在显著差异（分别为133分、155.9分和178.25分；p = 0.002）。H-OSATS量表显示出较高的评分者间信度（组内相关系数[ICC] = 0.930；p<0.001）和重测信度（ICC = 0.877；p<0.001）。H-OSATS总分与OSATS分数之间存在高度相关性（rho = 0.928；p<0.001）。
H-OSATS量表显示出在虚拟现实模拟器上对LH技术操作进行评估的有效性证据。该量表的实施有望促进刻意练习。下一步应侧重于评估该量表在手术室中的有效性。
