Department of Surgery, Gødstrup Hospital, Herning, Denmark.
Department of Surgery, Aarhus University, Aarhus, Denmark.
Colorectal Dis. 2023 Jan;25(1):31-43. doi: 10.1111/codi.16317. Epub 2022 Sep 16.
To (1) develop an assessment tool for laparoscopic complete mesocolic excision (LCME) and (2) report evidence of its content validity.
Assessment statements were revealed through (1) semi-structured expert interviews and (2) consensus by the Delphi method, both involving an expert panel of five LCME surgeons. All experts were interviewed and then asked to rate LCME describing statements from 1 (strongly disagree) to 5 (strongly agree). Responses were returned anonymously to the panel until consensus was reached. Statements were directly included as content in the assessment tool if ≥60% of the experts responded "agree" or "strongly agree" (ratings 4 and 5), with the remaining responses being "neither agree nor disagree" (rating 3). Interclass correlation coefficient (ICC) was calculated for expert agreement evaluation. All included statements were subsequently reformulated as tool items and approved by the experts.
Four Delphi rounds were performed to reach consensus. Disagreement was reported for statements describing instrument handling around pancreas; visualisation of landmarks before inferior mesenteric artery ligation; lymphadenectomy around the inferior mesenteric artery, and division of the terminal ileum and transverse colon. ICC in the last Delphi-round was 0.84. The final tool content included 73 statements, converted to 48 right- and 40 left-sided items for LCME assessment.
A procedure-specific, video-based tool, named complete mesocolic excision competency assessment tool (CMECAT), has been developed for LCME skill assessment. In the future, we hope it can facilitate assessment of LCME surgeons, resulting in improved patient outcome after colon cancer surgery.
（1）开发一种腹腔镜完整结肠系膜切除术（LCME）的评估工具，（2）报告其内容效度的证据。
评估陈述通过（1）半结构化专家访谈和（2）德尔菲法共识揭示，均涉及五位 LCME 外科医生的专家小组。所有专家都接受了访谈，然后被要求对 LCME 描述性陈述进行 1（非常不同意）到 5（非常同意）的评分。匿名向小组反馈答复，直到达成共识。如果≥60%的专家回答“同意”或“强烈同意”（评分 4 和 5），则直接将陈述作为评估工具的内容包含在内，其余回答为“既不同意也不反对”（评分 3）。计算专家一致性评估的组内相关系数（ICC）。所有包含的陈述随后被重新表述为工具项目，并得到专家的认可。
进行了四轮德尔菲法，以达成共识。在描述胰腺周围器械操作、肠系膜下动脉结扎前的标志物可视化、肠系膜下动脉周围淋巴结切除术以及回肠末端和横结肠分离的陈述上存在分歧。最后一轮德尔菲法的 ICC 为 0.84。最终的工具内容包括 73 个陈述，转换为 48 个右侧和 40 个左侧 LCME 评估项目。
已为 LCME 技能评估开发了一种特定于程序的、基于视频的工具，称为完整结肠系膜切除术能力评估工具（CMECAT）。未来，我们希望它能促进 LCME 外科医生的评估，从而改善结肠癌手术后患者的预后。
