Corson SL, Batzer FR, Gocial B, Kelly M, Gutmann JN, Maislin G
Philadelphia Fertility Institute, 815 Locust Street, Philadelphia, PA 19107-5507.
J Am Assoc Gynecol Laparosc. 1994 Aug;1(4, Part 2):S8. doi: 10.1016/s1074-3804(05)80891-6.
Videotapes of laparoscopic procedures are used for patient and physician education, independent consultation, and even in the courtroom as evidence. Validation of the interpretation of the videotape with respect to intraobserver and interobserver difference has been scarcely studied. As part of the protocol of a prospective, double-blind, placebo study a standardized adhesion scoring system was developed by the investigators. After laparoscopic adhesiolysis and instillation of either an active or placebo agent designed to prevent reformation of adhesions, a second look laparoscopy was performed between 6 and 10 weeks later to allow for a second adhesion score. Five reproductive surgeons evaluated via videotape pre and post adhesion scores in which 11 patients (22 procedures) were operated by one member of the group. Three months after the initial scoring of the videotapes each tape was reevaluated in order to measure intraobserver variability. Intraobserver and interobserver variability was assessed for adhesion extent as well as adhesion severity scores and also included consideration of the differences between the first and second procedures using sophisticated statistical methods. Intraobserver variability for adhesion severity was 12% versus 19% for interobserver variability. The replicate (intraobserver) variability for adhesion extent was 15.4% and interobserver variability was 21.2%. Two of the five observers consistently scored pathology as more severe than two others. The surgeon scored differences between the two procedures as greater than the other observers. Nevertheless, the variability was not so great as to preclude videotape evaluation of pathology in multicentric trials, or to allow for independent consultation of laparoscopic procedures via videotape.
腹腔镜手术录像用于患者和医生的教育、独立会诊，甚至在法庭上作为证据。关于录像带解读在观察者内和观察者间差异方面的验证研究很少。作为一项前瞻性、双盲、安慰剂研究方案的一部分，研究人员开发了一种标准化的粘连评分系统。在进行腹腔镜粘连松解术并注入旨在防止粘连重新形成的活性或安慰剂制剂后，在6至10周后进行第二次腹腔镜检查以获得第二个粘连评分。五位生殖外科医生通过录像带评估粘连术前和术后评分，其中该组的一名成员对11名患者（22例手术）进行了手术。在对录像带进行初始评分三个月后，对每一盘录像带进行重新评估，以测量观察者内变异性。使用复杂的统计方法评估了观察者内和观察者间在粘连范围以及粘连严重程度评分方面的变异性，还包括考虑第一次和第二次手术之间的差异。粘连严重程度的观察者内变异性为12%，观察者间变异性为19%。粘连范围的重复（观察者内）变异性为15.4%，观察者间变异性为21.2%。五位观察者中有两位始终将病理结果评为比其他两位更严重。该外科医生对两次手术之间差异的评分高于其他观察者。然而，变异性并没有大到排除在多中心试验中通过录像带评估病理情况，或通过录像带对腹腔镜手术进行独立会诊的可能性。
