Department of General, Visceral and Transplant Surgery, University Medical Center, Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
Department of General and Visceral Surgery, St. Georg Hospital, Eisenach, Germany.
Int J Colorectal Dis. 2020 Jun;35(6):1111-1115. doi: 10.1007/s00384-020-03543-9. Epub 2020 Mar 28.
In advanced minimally invasive surgery the laparoscopic camera navigation (LCN) quality can influence the flow of the operation. This study aimed to investigate the applicability of a scoring system for LCN (SALAS score) in colorectal surgery and whether an adequate scoring can be achieved using a specified sequence of the operation.
The score was assessed by four blinded raters using synchronized video and voice recordings of 20 randomly selected laparoscopic colorectal surgeries (group A: assessment of the entire operation; group B: assessment of the 2nd and 3rd quartile). Experience in LCN was defined as at least 100 assistances in complex laparoscopic procedures.
The surgical teams consisted of three residents, three fellows, and two attendings forming 15 different teams. The ratio between experienced and inexperienced camera assistants was balanced (n = 11 vs. n = 9). Regarding the total SALAS score, the four raters discriminated between experienced and inexperienced camera assistants, regardless of their group assignment (group A, p < 0.05; group B, p < 0.05). The score's interrater variability and reliability were proven with an intraclass correlation coefficient of 0.88. No statistically relevant correlation was achieved between operation time and SALAS score.
This study presents the first intraoperative, objective, and structured assessment of LCN in colorectal surgery. We could demonstrate that the SALAS score is a reliable tool for the assessment of LCN even when only the middle part (50%) of the procedure is analyzed. Construct validity was proven by discriminating between experienced and inexperienced camera assistants.
在高级微创外科中，腹腔镜摄像导航（LCN）的质量会影响手术的流畅性。本研究旨在探讨一种用于结直肠手术的 LCN 评分系统（SALAS 评分）的适用性，以及是否可以通过规定的手术步骤获得足够的评分。
四名盲评员使用同步的视频和语音记录评估了 20 例随机选择的腹腔镜结直肠手术（A 组：评估整个手术；B 组：评估第 2 和第 3 四分位数）。LCN 经验定义为至少完成 100 例复杂腹腔镜手术的辅助操作。
手术团队由三名住院医师、三名研究员和两名主治医生组成，共 15 个不同的团队。有经验和无经验的摄像助手之间的比例平衡（n=11 对 n=9）。关于总 SALAS 评分，四名评分员无论分组如何（A 组，p<0.05；B 组，p<0.05），都能区分有经验和无经验的摄像助手。评分的组内相关系数为 0.88，证明了其组内一致性和可靠性。手术时间与 SALAS 评分之间无统计学相关性。
本研究首次对结直肠手术中的 LCN 进行了术中、客观和结构化评估。我们证明，即使仅分析手术的中间部分（50%），SALAS 评分也是评估 LCN 的可靠工具。通过区分有经验和无经验的摄像助手，证明了其结构效度。
