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| Performance in the Fundamentals of Laparoscopic Surgery: Does it reflect global rating scales in the Objective Structured Assessment of Technical Skills in porcine laparoscopic surgery? |
Ho Yee Tionga,d,*( ),Wei Zheng Soa,Jeremy Yuen-Chun Teohb,Shuji Isotanic,Gang Zhue,Teng Aik Ongf,Eddie Shu-Yin Chanb,Peggy Sau-Kwan Chug,Kittinut Kijvikaih,Ming Liui,Bannakji Lojanapiwatj,Michael Wongk,Anthony Chi-Fai Ngb
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aYong Loo Lin School of Medicine, Department of Surgery, National University of Singapore, Singapore
bS.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
cDepartment of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan
dDepartment of Urology, National University Hospital, Singapore
eDepartment of Urology, Beijing United Family Hospital, Beijing, China
fDepartment of Surgery, University of Malaya Specialist Centre, Kuala Lumpur, Malaysia
gDivision of Urology, Department of Surgery, Tuen Mun Hospital, Hong Kong
hDepartment of Urology, Ramathibodi Hospital, Mahidol University, Salaya, Thailand
iDepartment of Urology, Beijing Hospital, Beijing, China
jDepartment of Urology, Chiangmai Ram Hospital, Chiang Mai, Thailand
kInternational Urology, Fertility & Gynaecology Centre, Singapore |
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Abstract Objective: To correlate the utility of the Fundamentals of Laparoscopic Surgery (FLS) manual skills program with the Objective Structured Assessment of Technical Skills (OSATS) global rating scale in evaluating operative performance. Methods: The Asian Urological Surgery Training and Educational Group (AUSTEG) Laparoscopic Upper Tract Surgery Course implemented and validated the FLS program for its usage in laparoscopic surgical training. Delegates’ basic laparoscopic skills were assessed using three different training models (peg transfer, precision cutting, and intra-corporeal suturing). They also performed live porcine laparoscopic surgery at the same workshop. Live surgery skills were assessed by blinded faculty using the OSATS rating scale. Results: From March 2016 to March 2019, a total of 81 certified urologists participated in the course, with a median of 5 years of post-residency experience. Although differences in task time did not reach statistical significance, those with more surgical experience were visibly faster at completing the peg transfer and intra-corporeal suturing FLS tasks. However, they took longer to complete the precision cutting task than participants with less experience. Overall OSATS scores correlated weakly with all three FLS tasks (peg transfer time: r=−0.331, r2=0.110; precision cutting time: r=−0.240, r2=0.058; suturing with intra-corporeal knot time: r=−0.451, r2=0.203). Conclusion: FLS task parameters did not correlate strongly with OSATS globing rating scale performance. Although FLS task models demonstrated strong validity, it is important to assimilate the inconsistencies when benchmarking technical proficiency against real-life operative competence, as evaluated by FLS and OSATS, respectively.
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Received: 17 July 2022
Available online: 20 July 2024
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Corresponding Authors:
*Department of Urology, National University Hospital, Singapore. E-mail address: surthy@nus.edu.sg (H.Y. Tiong).
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| Baseline characteristics | ≤10 LNsa (n=54) | >10 LNsb (n=27) | p-Value | | Gender, n (%) | | | >0.05 | | Male | 49 (90.7) | 25 (92.6) | | | Female | 5 (9.3) | 2 (7.4) | | | Designation, n (%) | | | 0.914 | | Resident | 2 (3.7) | 0 (0) | | | Consultant | 30 (55.6) | 16 (59.3) | | | Senior consultant | 22 (40.7) | 11 (40.7) | | | Have performed at least one LN in the past 6 months, n (%) | | | 0.547 | | Yes | 51 (94.4) | 27 (100) | | | No | 3 (5.6) | 0 (0) | |
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Baseline characteristics of participating urologists from March 2016 to March 2019.
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Questionnaire demonstrating validity of the Fundamentals of Laparoscopic Surgery task models.
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| Tasks | Performance time, s | p-Value | | ≤10 LNsa (n=54) | >10 LNsb (n=27) | | Peg transfer | 148.8±52.4 | 138.4±56.7 | 0.200 | | Precision cutting | 232.3±112.2 | 252.4±144.7 | 0.767 | | Intra-corporeal suturing | 280.7±169.8 | 247.1±152.4 | 0.296 |
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FLS task time of participating urologists.
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| Component | OSATS evaluation scores | p-Value | | ≤10 LNsa (n=54) | >10 LNsb (n=27) | | Respect of tissue | 3.76±0.60 | 4.03±0.42 | 0.073 | | Time and motion | 3.55±0.75 | 3.56±0.62 | 0.765 | | Instrument handling | 3.66±0.69 | 3.77±0.56 | 0.617 | | Knowledge of instruments | 4.02±0.54 | 4.06±0.58 | 0.491 | | Flow of operation | 3.68±0.63 | 3.81±0.72 | 0.325 | | Use of assistant | 3.69±0.61 | 3.84±0.62 | 0.246 | | Procedure knowledge | 3.84±0.68 | 3.97±0.65 | 0.521 | | Overall | 3.74±0.56 | 3.86±0.48 | 0.365 |
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OSATS evaluation parameters of participating urologists.
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Correlation between peg transfer time and OSATS mean overall scores. OSATS, the Objective Structured Assessment of Technical Skills.
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Correlation between precision cutting time and OSATS mean overall scores. OSATS, the Objective Structured Assessment of Technical Skills.
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Correlation between intra-corporeal suturing time and OSATS mean overall scores. OSATS, the Objective Structured Assessment of Technical Skills.
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