Abstract
Background
Laparoscopic incisional hernia repair (LIHR) is a common procedure requiring advanced laparoscopic skills. This study aimed to develop a procedure-specific tool to assess the performance of LIHR and to evaluate its reliability and validity.
Methods
The Global Operative Assessment of Laparoscopic Skills-Incisional Hernia (GOALS-IH) is a 7-item global rating scale developed by experts to evaluate the steps of LIHR (placement of trocars, adhesiolysis, estimation of mesh size and shape, mesh orientation and positioning, mesh fixation, knowledge and autonomy in use of instruments, overall competence), each rated on a 5-point Likert scale. During LIHR, 13 attending surgeons and fellows experienced in minimally invasive surgery (MIS) and 19 novice surgeons (postgraduate years [PGYs], 3–5) were evaluated at four teaching hospitals by the attending surgeon, a trained observer, and self-assessment using GOALS-IH, and by a previously validated 5-item general laparoscopic rating scale (GOALS). Interrater reliability was assessed by intraclass correlation (ICC), and internal consistency of rating items was assessed by Cronbach’s alpha. Known-groups construct validity was assessed by using the t-test and by correlating of the number of self-reported LIHR cases with the total score. Concurrent validity was assessed by correlating the GOALS-IH score with the GOALS general rating scale. Data are presented as mean and 95% confidence interval (CI).
Results
Interrater reliability for the total GOALS-IH score was 0.79 (95% CI, 0.60–0.89) between observers and attending surgeons, 0.81 (95% CI, 0.58–0.92) between participants and attending surgeons, and 0.89 (95% CI, 0.76–0.96) between participants and observers. Internal consistency was high (Cronbach’s alpha, 0.93). Experienced surgeons performed significantly better than novices as assessed by GOALS-IH (31; 95% CI, 29–33 vs. 21; 95% CI, 19–24; p < 0.01). Very good correlation was found between GOALS-IH and previous LIHR experience (r = 0.82; p < 0.01) and strong correlation between GOALS-IH and generic GOALS total scores (r = 0.90; p < 0.01).
Conclusion
Surgical performance during clinical LIHR can be assessed reliably using GOALS-IH. Results can be used to provide formative feedback to the surgeon and to identify steps of the operation that would benefit from specific educational interventions.
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Acknowledgment
The authors thank Drs. Carlos Godinez, Ajita Prabhu, and Todd Heniford for their help in data collection and coordination during the study. This study is supported by a research grant from the Canadian Association of General Surgeons (CAGS). The Steinberg-Bernstein Centre is supported by an unrestricted educational grant from Covidien Canada.
Disclosure
Iman Ghaderi received salary support from the Postgraduate Medical Education office at the University of Western Ontario. Marilou Vaillancourt, Gideon Sroka, Pepa A. Kaneva, Melina C. Vassiliou, Ian Choy, Allan Okrainec, F. Jacob Seagull, Erica Sutton, Ivan George, Adrian Park, Rita Brintzenhoff, Dimitrios Stefanidis, Gerald M. Fried, and Liane S. Feldman have no conflicts of interest or financial ties to disclose.
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Ghaderi, I., Vaillancourt, M., Sroka, G. et al. Evaluation of surgical performance during laparoscopic incisional hernia repair: a multicenter study. Surg Endosc 25, 2555–2563 (2011). https://doi.org/10.1007/s00464-011-1586-4
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DOI: https://doi.org/10.1007/s00464-011-1586-4