GKT School of Medical Education, King's College London, Guy's Campus, St. Thomas Street, London, UK.
Division of Transplantation Immunology & Mucosal Biology, Faculty of Life Sciences & Medicine, Guy's Hospital, MRC Centre for Transplantation, King's College London, London, UK.
Surg Endosc. 2018 Nov;32(11):4402-4407. doi: 10.1007/s00464-018-6407-6. Epub 2018 Sep 7.
With the increased use of simulation for surgical training, there is a need for objective forms of assessment to evaluate trainees. The Global Evaluative Assessment of Robotic Skills (GEARS) is widely used for assessing skills in robotic surgery, but there are no recognised checklist scoring systems. This study aimed to develop a checklist for suturing in robotic surgery.
A suturing checklist for needle driving and knot tying was constructed following evaluation of participants performing urethrovesical anastomoses. Key procedural steps were identified from expert videos, while assessing novice videos allowed identification of common technical errors. 22 novice and 13 expert videos were marked on needle driving, while 18 novices and 10 experts were assessed on knot tying. Validation of the finalised checklist was performed with the assessment of 39 separate novices by an expert surgeon and compared to GEARS scoring.
The internal consistency of the preliminary checklist was high (Cronbach's alpha = 0.870 for needle driving items; 0.736 for knot tying items), and after removal of poorly correlating items, the final checklist contained 23 steps. Both the needle driving and knot tying categories discriminated between novices and experts, p < 0.005. While the GEARS score demonstrated construct validity for needle driving, it could not significantly differentiate between novices and experts for knot tying, p = 0.286. The needle driving category significantly correlated with the corresponding GEARS scores (r = 0.613, p < 0.005), but the correlation for knot tying was insignificant (r = 0.296, p = 0.127). The pilot data indicates the checklist significantly correlated with the GEARS score (p < 0.005).
This study reports the development of a valid assessment tool for suturing in robotic surgery. Given that checklists are simple to use, there is significant scope for this checklist to be used in surgical training.
随着模拟技术在外科培训中的应用日益增多，需要有客观的评估形式来评估学员。全球机器人技能评估（GEARS）广泛用于评估机器人手术技能，但目前还没有公认的检查表评分系统。本研究旨在开发一种用于机器人手术缝合的检查表。
在评估参与者进行尿道膀胱吻合术之后，构建了用于针驱动和打结的缝合检查表。从专家视频中确定了关键的操作步骤，同时评估新手视频可以识别常见的技术错误。对 22 名新手和 13 名专家进行了针驱动标记，对 18 名新手和 10 名专家进行了打结标记。由一名专家外科医生对 39 名新手进行最终检查表的验证，并与 GEARS 评分进行比较。
初步检查表的内部一致性很高（针驱动项目的 Cronbach's alpha 为 0.870；打结项目的 Cronbach's alpha 为 0.736），并且在删除相关性较差的项目后，最终检查表包含 23 个步骤。针驱动和打结类别都可以区分新手和专家，p<0.005。虽然 GEARS 评分对针驱动具有结构有效性，但它不能显著区分新手和专家的打结能力，p=0.286。针驱动类别与相应的 GEARS 评分显著相关（r=0.613，p<0.005），但打结的相关性不显著（r=0.296，p=0.127）。初步数据表明，检查表与 GEARS 评分显著相关（p<0.005）。
本研究报告了一种用于机器人手术缝合的有效评估工具的开发。鉴于检查表易于使用，因此这种检查表在外科培训中具有广泛的应用前景。
