Development of a novel tool to assess skills in laparoscopic gastrectomy using the Delphi method: the Japanese operative rating scale for laparoscopic distal gastrectomy (JORS-LDG)



Assessment of the performance of laparoscopic gastrectomy is yet unreported, likely because of the complexity of the procedure. We aimed to develop a tool to assess the skills required for laparoscopic distal gastrectomy (LDG) through cognitive task analysis (CTA) and expert consensus using the Delphi method.


CTA involved the listing of the knowledge and criteria required for completing each step of LDG as subtasks based on interviews by experts and novices and text book, instructional video, and procedural review. The Delphi evaluation method involved anonymous online surveys, conducted to merge the opinions of experts in laparoscopic gastrectomy. The experts were asked to rate (from 1 to 5) the importance of subtasks for skill evaluation and training for LDG using a Likert scale. Consensus among expert viewpoints was determined by the internal consistency of each item using Cronbach’s approach.


Essential subtasks drafted for the assessment of LDG performance were determined based on the CTA. Thirty-one LDG experts participated in the online-survey with a response rate over 90%. A consensus was achieved after 2 rounds of surveys with a Cronbach alpha of 0.86, and 34 subtasks of LDG were selected. We finally created the Japanese Operative Rating Scale for Laparoscopic Distal Gastrectomy (JORS-LDG) based on the 34 subtasks.


We developed the JORS-LDG using CTA and the Delphi method.

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The author would like to thank the 31 laparoscopic surgeons who participated in this study. We could not complete this study without their kind support.

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Correspondence to Yo Kurashima.

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Dr. Yo Kurashima is a consultant at Ethicon. Drs. Yusuke Watanabe, Naoki Hiki, Saseem Poudel, Hidehiko Kitagami, Yuma Ebihara, Soichi Murakami, Toshiaki Shichinohe, and Satoshi Hirano have no conflicts of interest or financial ties to disclose.

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Kurashima, Y., Watanabe, Y., Hiki, N. et al. Development of a novel tool to assess skills in laparoscopic gastrectomy using the Delphi method: the Japanese operative rating scale for laparoscopic distal gastrectomy (JORS-LDG). Surg Endosc 33, 3945–3952 (2019).

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  • Laparoscopy
  • Gastrectomy
  • Assessment
  • Delphi
  • Surgical education