World Journal of Surgery

, Volume 34, Issue 7, pp 1594–1603 | Cite as

Assessing Operative Performance in Advanced Laparoscopic Colorectal Surgery




Competent technical skills performance in complex operations is vital for satisfactory patient outcome. Assessing these skills is therefore of paramount importance. In this study we aim to develop and validate a new tool that can assess both generic and specific technical skills in advanced complex laparoscopic colorectal surgery in the operating room.


Hierarchical task analysis was constructed for generic and specific technical skills on three key advanced laparoscopic colorectal operations (right hemicolectomy, sigmoid colectomy, and anterior resection) after expert discussions. Likert scales were then constructed individually for generic and specific technical skills for each operation using hierarchical task analysis for each operation to identify key elements and steps for each operation. Each operation was assessed independently and blindly by two experienced surgeons.


Eighty-four live real operations performed by six consultants and eight trainees were assessed. Interclass correlation coefficient between the two observers was 0.94 (P ≤ 0.05) for generic technical skills and 0.88 (P ≤ 0.05) for the operation-specific technical skills. Construct validity for both generic and specific technical skills for consultants and trainees was significant using ANOVA (P ≤ 0.05). All consultants therefore consistently performed better in both generic and specific technical skills compared to their trainees.


This new assessment tool of generic and specific technical skills in advanced laparoscopic colorectal surgery is reliable and has face, content, concurrent, and construct validities. The tool has the possibility of being used as a surgical training and appraisal tool.



We thank the surgical and nursing staff at the hospitals in West and North London and University of Cleveland Hospitals for their help.


  1. 1.
    Baker GR, Norton PG, Flintoft V et al (2004) The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada. CMAJ 170:1678–1686PubMedGoogle Scholar
  2. 2.
    Brennan TA, Leape LL, Laird NM et al (1991) Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. N Engl J Med 324:370–376PubMedGoogle Scholar
  3. 3.
    Vincent C, Neale G, Woloshynowych M (2001) Adverse events in British hospitals: preliminary retrospective record review. BMJ 322:517–519CrossRefPubMedGoogle Scholar
  4. 4.
    The Southern Surgeons Club (1991) A prospective analysis of 1518 laparoscopic cholecystectomies. N Engl J Med 324:1073–1078CrossRefGoogle Scholar
  5. 5.
    Moorthy K, Munz Y, Sarker SK et al (2003) Objective assessment of technical skills in surgery. BMJ 327:1032–1037CrossRefPubMedGoogle Scholar
  6. 6.
    Martin JA, Regehr G, Reznick R et al (1997) Objective structured assessment of technical skill (OSATS) for surgical residents. Br J Surg 84:273–278CrossRefPubMedGoogle Scholar
  7. 7.
    Sarker SK, Chang A, Vincent C et al (2006) Development of assessing generic and specific technical skills in laparoscopic surgery. Am J Surg 191:238–244CrossRefPubMedGoogle Scholar
  8. 8.
    Friedman Z, Katznelson R, Devito I et al (2006) Objective assessment of manual skills and proficiency in performing epidural anesthesia—video-assisted validation. Reg Anesth Pain Med 31:304–310PubMedGoogle Scholar
  9. 9.
    Moorthy K, Munz Y, Dosis A et al (2004) Bimodal assessment of laparoscopic suturing skills: construct and concurrent validity. Surg Endosc 18:1608–1612PubMedGoogle Scholar
  10. 10.
    Swift SE, Carter JF (2006) Institution and validation of an observed structured assessment of technical skills (OSATS) for obstetrics and gynecology residents and faculty. Am J Obstet Gynecol 195:617–621CrossRefPubMedGoogle Scholar
  11. 11.
    van der Heide PA, van Toledo-Eppinga L, van der HM et al (2006) Assessment of neonatal resuscitation skills: a reliable and valid scoring system. Resuscitation 71:212–221CrossRefPubMedGoogle Scholar
  12. 12.
    Watterson JD, Beiko DT, Kuan JK et al (2002) Randomized prospective blinded study validating acquisition of ureteroscopy skills using computer based virtual reality endourological simulator. J Urol 168:1928–1932CrossRefPubMedGoogle Scholar
  13. 13.
    Dath D, Regehr G, Birch D et al (2004) Toward reliable operative assessment: the reliability and feasibility of videotaped assessment of laparoscopic technical skills. Surg Endosc 18:1800–1804CrossRefPubMedGoogle Scholar
  14. 14.
    Joice P, Hanna GB, Cuschieri A (1998) Errors enacted during endoscopic surgery—a human reliability analysis. Appl Ergon 29:409–414CrossRefPubMedGoogle Scholar
  15. 15.
    Sarker SK, Albrani T, Zaman A et al (2008) Procedural performance in gastrointestinal endoscopy: an assessment and self-appraisal tool. Am J Surg 196(3):450–455CrossRefPubMedGoogle Scholar
  16. 16.
    Sarker SK, Chang A, Albrani T et al (2008) Constructing a hierarchical task analysis in surgery. Surg Endosc 22(1):107–111CrossRefPubMedGoogle Scholar
  17. 17.
    Sarker SK, Chang A, Vincent C (2006) Assessing technical and technological skills in laparoscopic surgery. JSLS 10(3):284–292PubMedGoogle Scholar
  18. 18.
    Sarker SK, Hutchinson R, Chang A et al (2006) Self-appraisal hierarchical task analysis of expert surgeons performing laparoscopic surgery. Surg Endosc 20(4):636–640CrossRefPubMedGoogle Scholar
  19. 19.
    Aggarwal R, Grantcharov T, Moorthy K et al (2005) A reliability analysis of video-based rating scales for technical skills assessments in laparoscopic surgery. Surg Endosc 19:s286Google Scholar
  20. 20.
    Sarker SK, Chang A, Vincent C et al (2005) Assessment of technical skills in open and laparoscopic surgery. Br J Surg 92:s22–s23Google Scholar
  21. 21.
    Albrani T, Zaman A, Patel B et al (2007) Self appraisal and assessment of technical skills in endoscopic procedures. Gut 56:A86Google Scholar
  22. 22.
    Sarker SK, Chang A, Vincent C et al (2004) Self-appraisal of senior surgeons using objective structured assessment of technical skill in laparoscopic cholecystecomies. Surg Endosc 18:s233Google Scholar
  23. 23.
    Burt CG, Wilkins DC (2005) The accuracy of self-assessment by surgical trainees. Br J Surg 92:s140CrossRefGoogle Scholar
  24. 24.
    Beard JD, Thomas WE, Rochester J et al (2005) Developing assessments of surgical skills for GMC performance procedures. Br J Surg 92:s147CrossRefGoogle Scholar
  25. 25.
    Reznick RK (1993) Teaching and testing technical skills. Am J Surg 165:358–361CrossRefPubMedGoogle Scholar
  26. 26.
    Brewster LP, Risucci DA, Joehl RJ et al (2008) Comparison of resident self-assessments with trained faculty and standardized patient assessments of clinical and technical skills in a structured educational module. Am J Surg 195(1):1–4CrossRefPubMedGoogle Scholar
  27. 27.
    Eubanks TR, Clements RH, Pohl D et al (1999) An objective scoring system for laparoscopic cholecystectomy. J Am Coll Surg 189:566–574CrossRefPubMedGoogle Scholar
  28. 28.
    Aggarwal R, Boza C, Hance J et al (2007) Training in laparoscopic Roux-en-Y gastric bypass—an evidence-based approach. Obes Surg 17:19–27CrossRefPubMedGoogle Scholar
  29. 29.
    Beard JD, Choksy S, Khan S (2007) Assessment of operative competence during carotid endarterectomy. Br J Surg 94:726–730CrossRefPubMedGoogle Scholar
  30. 30.
    Vassiliou MC, Feldman LS, Andrew CG et al (2005) A global assessment tool for evaluation of intraoperative laparoscopic skills. Am J Surg 190:107–113CrossRefPubMedGoogle Scholar
  31. 31.
    Gumbs AA, Hogle NJ, Fowler DL (2007) Evaluation of resident laparoscopic performance using global operative assessment of laparoscopic skills. J Am Coll Surg 204:308–313CrossRefPubMedGoogle Scholar
  32. 32.
    Larson JL, Williams RG, Ketchum J et al (2005) Feasibility, reliability and validity of an operative performance rating system for evaluating surgery residents. Surgery 138:640–647CrossRefPubMedGoogle Scholar
  33. 33.
    Zirkle M, Taplin MA, Anthony R (2007) Objective assessment of temporal bone drilling skills. Ann Otol Rhinol Laryngol 116(11):793–798PubMedGoogle Scholar
  34. 34.
    Black SA, Harrison RH, Horrocks EJ et al (2007) Competence assessment of senior vascular trainees using a carotid endarterectomy bench model. Br J Surg 94(10):1226–1231CrossRefPubMedGoogle Scholar
  35. 35.
    Sarker SK (2006) Assessment of technical skills in surgery. PhD Thesis, Imperial College London, University of LondonGoogle Scholar
  36. 36.
    Sarker SK (2004) Operative surgical safety—it’s good to talk. Bull R Coll Physicians Surg Glasg 33(3):2Google Scholar
  37. 37.
    Haynes AB, Weiser TG, Berry WR et al (2009) Safe Surgery Saves Lives Study Group: a surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 360(5):491–499CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2010

Authors and Affiliations

  1. 1.Colorectal Surgical UnitWhittington HospitalLondonUK
  2. 2.Academic SurgeryUniversity College LondonLondonUK
  3. 3.Department of Colorectal SurgeryUniversity Hospitals Case Medical CentreClevelandUSA
  4. 4.LondonUK

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