Skip to main content

Advertisement

SpringerLink
Log in

Development of a novel educational tool to assess skills in laparoscopic liver surgery using the Delphi methodology: the laparoscopic liver skills scale (LLSS)

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

No specific performance assessment scales have been reported in laparoscopic liver resection. This study aimed at developing an objective scale specific for the assessment of technical skills for wedge resection in anterior segments (WRAS) and left lateral sectionectomy (LLS).

Methods

A laparoscopic liver skills scale (LLSS) was developed using a hierarchical task analysis. A Delphi method obtained consensus among five international experts on relevant steps that should be included into the LLSS for assessment of operative performances. The consensus was predefined using Cronbach’s alpha > 0.80.

Results

A semi-structured review extracted 15 essential subtasks for full laparoscopic WRAS and LLS for evaluation in the Delphi survey. Two rounds of the survey were conducted. Three over 15 subtasks did not reach the predefined level of consensus. Based on the expert’s comments, 13 subtasks were reformulated, 4 subtasks were added, and a revised skills scale was developed. After the 2nd round survey (Cronbach’s alpha 0.84), 19 subtasks were adopted. The LLSS was composed of three main parts: patient positioning and intraoperative preparation (task 1 to 8), the core part of the WRAS and LLS procedure (tasks 9 to 14), and completion of procedure (task 15 to 19).

Conclusions

The LLSS was developed for measuring the skill set for the education of safe and secure laparoscopic WRAS and LLS procedures in a dedicated training program. After validation, this scale could be also used as an assessment tool in the operating room and extrapolated as an operative roadmap to other complex procedures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Derevianko AY, Schwaitzberg SD, Tsuda S, Barrios L, Brooks DC, Callery MP, Fobert D, Irias N, Rattner DW, Jones DB (2010) Malpractice carrier underwrites fundamentals of laparoscopic surgery training and testing: a benchmark for patient safety. Surg Endosc 24:616–623

    Article  PubMed  Google Scholar 

  2. Hafford ML, Van Sickle KR, Willis RE, Wilson TD, Gugliuzza K, Brown KM, Scott DJ (2013) Ensuring competency: are fundamentals of laparoscopic surgery training and certification necessary for practicing surgeons and operating room personnel? Surg Endosc 27:118–126

    Article  PubMed  Google Scholar 

  3. Sutherland LM, Middleton PF, Anthony A, Hamdorf J, Cregan P, Scott D, Maddern GJ (2006) Surgical simulation: a systematic review. Ann Surg 243:291–300

    Article  PubMed  PubMed Central  Google Scholar 

  4. Grantcharov TP, Kristiansen VB, Bendix J, Bardram L, Rosenberg J, Funch-Jensen P (2004) Randomized clinical trial of virtual reality simulation for laparoscopic skills training. Br J Surg 91:146–150

    Article  CAS  PubMed  Google Scholar 

  5. Seymour NE, Gallagher AG, Roman SA, O’Brien MK, Bansal VK, Andersen DK, Satava RM (2002) Virtual reality training improves operating room performance: results of a randomized, double-blinded study. Ann Surg 236:458–463

    Article  PubMed  PubMed Central  Google Scholar 

  6. Scott DJ, Bergen PC, Rege RV, Laycock R, Tesfay ST, Valentine RJ, Euhus DM, Jeyarajah DR, Thompson WM, Jones DB (2000) Laparoscopic training on bench models: better and more cost effective than operating room experience? J Am Coll Surg 191:272–283

    Article  CAS  PubMed  Google Scholar 

  7. Beyer L, De Troyer J, Mancini J, Bladou F, Berdah SV, Karsenty G (2011) Impact of laparoscopy simulator training on the technical skills of future surgeons in the operating room: a prospective study. Am J Surg 202:265–272

    Article  PubMed  Google Scholar 

  8. De Win G, Van Bruwaene S, Kulkarni J, Van Calster B, Aggarwal R, Allen C, Lissens A, De Ridder D, Miserez M (2016) An evidence-based laparoscopic simulation curriculum shortens the clinical learning curve and reduces surgical adverse events. Adv Med Educ Pract 30:357–370

    Article  Google Scholar 

  9. Bansal VK, Raveendran R, Misra MC, Bhattacharjee H, Rajan K, Krishna A, Kumar P, Kumar S (2014) A prospective randomized controlled blinded study to evaluate the effect of short-term focused training program in laparoscopy on operating room performance of surgery residents (CTRI /2012/11/003113). J Surg Educ 71:52–60

    Article  PubMed  Google Scholar 

  10. Ciria R, Cherqui D, Geller DA, Briceno J, Wakabayashi G (2016) Comparative short-term benefits of laparoscopic liver resection: 9000 cases and climbing. Ann Surg 263:761–777

    Article  PubMed  Google Scholar 

  11. Tranchart H, Dagher I (2014) Laparoscopic liver resection: a review. J Visc Surg 151:114–122

    Article  Google Scholar 

  12. Abu Hilal M, Aldrighetti L, Dagher I, Edwin B, Troisi RI, Alikhanov R, Aroori S, Belli G, Besselink M, Briceno J, Gayet B, D’Hondt M, Lesurtel M, Menon K, Lodge P, Rotellar F, Santoyo J, Scatton O, Soubrane O, Sutcliffe R, Van Dam R, White S, Halls MC, Cipriani F, Van der Poel M, Ciria R, Barkhatov L, Gomez-Luque Y, Ocana-Garcia S, Cook A, Buell J, Clavien PA, Dervenis C, Fusai G, Geller D, Lang H, Primrose J, Taylor M, Van Gulik T, Wakabayashi G, Asbun H, Cherqui D (2018) The Southampton consensus guidelines for laparoscopic liver surgery. Ann Surg 268:11–18

    Article  PubMed  Google Scholar 

  13. Azagra JS, Goergen M, Brondello S, Calmes MO, Philippe P, Schmitz B (2009) Laparoscopic liver sectionectomy 2 and 3 (LLS 2 and 3): towards the ‘“gold standard.”’ J Hepatobiliary Pancreat Surg 16:422–426

    Article  CAS  PubMed  Google Scholar 

  14. Chang S, Laurent A, Tayar C, Karoui M, Cherqui D (2007) Laparoscopy as a routine approach for left lateral sectionectomy. Br J Surg 94:58–63

    Article  CAS  PubMed  Google Scholar 

  15. Rao A, Rao G, Ahmed I (2011) Laparoscopic left lateral liver resection should be a standard operation. Surg Endosc 25:1603–1610

    Article  PubMed  Google Scholar 

  16. Guilbaud T, Birnbaum DJ, Berdah S, Farges O, Beyer Berjot L (2019) Learning curve in laparoscopic liver resection, educational value of simulation and training programmes: a systematic review. World J Surg 43:2710–2719

    Article  PubMed  Google Scholar 

  17. Rashidian N, Willaert W, Giglio MC, Scuderi V, Tozzi F, Vanlander A, D’Herde K, Alseidi A, Troisi RI (2019) Laparoscopic liver surgery training course on thiel-embalmed human cadavers: program evaluation, trainer’s long-term feedback and steps forward. World J Surg 43:2902–2908

    Article  PubMed  Google Scholar 

  18. Xiao J, Cui Z, Fu M, Kong X, Tang L, Wang Z, You F, Du Q, Li L (2016) An ex vivo liver training model continuously perfused to simulate bleeding for suture skills involved in laparoscopic liver resection: development and validity. Surg Endosc 30:4553–4561

    Article  PubMed  Google Scholar 

  19. Liu W, Zheng X, Wu R, Jin Y, Kong S, Li J, Lu J, Yang H, Xu X, Lv Y, Zhang X (2018) Novel laparoscopic training system with continuously perfused ex-vivo porcine liver for hepatobiliary surgery. Surg Endosc 32:743–750

    Article  CAS  PubMed  Google Scholar 

  20. Udomsawaengsup S, Pattana-arun J, Tansatit T, Pungpapong S, Navicharern P, Sirichindakul B, Nonthasoot B, Park-art R, Sriassadaporn S, Kyttayakerana K, Wongsaisuwan M, Rojanasakul A (2005) Minimally invasive surgery training in soft cadaver (MIST-SC). J Med Assoc Thai 88:S189-194

    PubMed  Google Scholar 

  21. Teh SH, Hunter JG, Sheppard BC (2007) A suitable animal model for laparoscopic hepatic resection training. Surg Endosc 21:1738–1744

    Article  PubMed  Google Scholar 

  22. Kurashima Y, Feldman LS, Al-Sabah S, Kaneva PA, Fried GM, Vassiliou MC (2011) A tool for training and evaluation of laparoscopic inguinal hernia repair: the global operative assessment of laparoscopic skills-groin hernia (GOALS-GH). Am J Surg 201:54–61

    Article  PubMed  Google Scholar 

  23. Poudel S, Kurashima Y, Kawarada Y, Watanabe Y, Murakami Y, Matsumura Y, Kato H, Miyazaki K, Shichinohe T, Hirano S (2016) Development and validation of a checklist for assessing recorded performance of laparoscopic inguinal hernia repair. Am J Surg 212:468–474

    Article  PubMed  Google Scholar 

  24. Palter VN, Grantcharov TP (2012) A prospective study demonstrating the reliability and validity of two procedure-specific evaluation tools to assess operative competence in laparoscopic colorectal surgery. Surg Endosc 26:2489–2503

    Article  PubMed  Google Scholar 

  25. Zevin B, Bonrath EM, Aggarwal R, Dedy NJ, Ahmed N, Grantcharov TP (2013) Development, feasibility, validity, and reliability of a scale for objective assessment of operative performance in laparoscopic gastric bypass surgery. J Am Coll Surg 216:955–965

    Article  PubMed  Google Scholar 

  26. Knight S, Aggarwal R, Agostini A, Loundou A, Berdah S, Crochet P (2018) Development of an objective assessment tool for total laparoscopic hysterectomy: a Delphi method among experts and evaluation on a virtual reality simulator. PLoS ONE 13:e0190580

    Article  PubMed  PubMed Central  Google Scholar 

  27. Kurashima Y, Watanabe Y, Hiki N, Poudel S, Kitagami H, Ebihara Y, Murakami S, Shichinohe T, Hirano S (2019) 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

    Article  PubMed  Google Scholar 

  28. Sarker SK, Chang A, Albrani T, Vincent C (2008) Constructing hierarchical task analysis in surgery. Surg Endosc 22:107–111

    Article  PubMed  Google Scholar 

  29. Wakabayashi G, Nitta H, Takahara T, Shimazu M, Kitajima M, Sasaki A (2009) Standardization of basic skills for laparoscopic liver surgery towards laparoscopic donor hepatectomy. J Hepatobiliary Pancreat Surg 16:439–444

    Article  PubMed  Google Scholar 

  30. Yoon YS, Han HS, Choi YS, Lee SI, Jang JY, Suh KS, Kim SW, Lee KU, Park YH (2006) Total laparoscopic left lateral sectionectomy performed in a child with benign liver mass. J Pediatr Surg 41:e25-28

    Article  PubMed  Google Scholar 

  31. Han HS, Cho JY, Yoon YS (2009) Techniques for performing laparoscopic liver resection in various hepatic locations. J Hepatobiliary Pancreat Surg 16:427–432

    Article  PubMed  Google Scholar 

  32. Wang X, Li J, Wang H, Luo Y, Ji W, Duan W, Zhang X, Guo S, Xu K, Dong J, Zheng S (2013) Validation of the laparoscopically stapled approach as a standard technique for left lateral segment liver resection. World J Surg 37:806–811

    Article  PubMed  Google Scholar 

  33. Scatton O, Katsanos G, Boillot O, Goumard C, Bernard D, Stenard F, Perdigao F, Soubrane O (2015) Pure laparoscopic left lateral sectionectomy in living donors: from innovation to development in France. Ann Surg 261:506–512

    Article  PubMed  Google Scholar 

  34. Fink A, Kosecoff J, Chassin M, Brook RH (1984) Consensus methods: characteristics and guidelines for use. Am J Public Health 74:979–983

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Jones J, Hunter D (1995) Consensus methods for medical and health services research. BMJ 311:376–380

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Singh P, Aggarwal R, Zevin B, Grantcharov T, Darzi A (2014) A global Delphi consensus study on defining and measuring quality in surgical training. J Am Coll Surg 219:346–353

    Article  PubMed  Google Scholar 

  37. van der Poel MJ, Huisman F, Busch OR, Abu Hilal M, van Gulik TM, Tanis PJ, Besselink MG (2017) Stepwise introduction of laparoscopic liver surgery: validation of guideline recommendations. HPB (Oxford) 19:894–900

    Article  Google Scholar 

  38. Von Der Gracht HA (2012) Consensus measurement in Delphi studies Review and implications for future quality assurance. Technol Forecast Soc Change 79:1525–1536

    Article  Google Scholar 

  39. Diamond IR, Grant RC, Feldman BM, Pencharz PB, Ling SC, Moore AM, Wales P (2014) Defining consensus: a systematic review recommends methodologic criteria for reporting of Delphi studies. J Clin Epidemiol 67:401–409

    Article  PubMed  Google Scholar 

  40. Martin JA, Regehr G, Reznick R, MacRae H, Murnaghan J, Hutchison C, Brown M (2006) Objective structured assessment of technical skill (OSATS) for surgical residents. Br J Surg 355:2664–2669

    Google Scholar 

  41. Helling TS, Khandelwal A (2008) The challenges of resident training in complex hepatic, pancreatic, and biliary procedures. J Gastrointest Surg 12:153–158

    Article  PubMed  Google Scholar 

  42. Subhas G, Mittal VK (2011) Training minimal invasive approaches in hepatopancreatobilliary fellowship: the current status. HPB (Oxford) 13:149–152

    Article  Google Scholar 

  43. Halls MC, Alseidi A, Berardi G, Cipriani F, Van der Poel M, Davila D, Ciria R, Besselink M, D’Hondt M, Dagher I, Alrdrighetti L, Troisi RI, Abu Hilal M (2019) A comparison of the learning curves of laparoscopic liver surgeons in differing stages of the IDEAL paradigm of surgical innovation: standing on the shoulders of pioneers. Ann Surg 269:221–228

    Article  PubMed  Google Scholar 

  44. Aldrighetti L, Cipriani F, Fiorentini G, Catena M, Paganelli M, Ratti F (2019) A stepwise learning curve to define the standard for technical improvement in laparoscopic liver resections: complexity-based analysis in 1032 procedures. Updates Surg 71:273–283

    Article  PubMed  Google Scholar 

  45. Robinson SM, Hui KY, Amer A, Manas DM, White SA (2012) Laparoscopic liver resection: is there a learning curve? Dig Surg 29:62–69

    Article  PubMed  Google Scholar 

  46. Ratti F, Barkhatov LI, Tomassini F, Cipriani F, Kazaryan AM, Edwin B, Abu Hilal M, Troisi RI, Aldrighetti L (2016) Learning curve of self-taught laparoscopic liver surgeons in left lateral sectionectomy: results from an international multi-institutional analysis on 245 cases. Surg Endosc 30:3618–3629

    Article  PubMed  Google Scholar 

  47. Villani V, Bohnen JD, Torabi R, Sabbatino F, Chang DC, Ferrone CR (2016) “Idealized” vs. “True” learning curves: the case of laparoscopic liver resection. HPB (Oxford) 18:504–509

    Article  Google Scholar 

  48. Beyer-Berjot L, Palter V, Grantcharov T, Aggarwal R (2014) Advanced training in laparoscopic abdominal surgery (Atlas): a systematic review. Surgery 156:676–688

    Article  PubMed  Google Scholar 

  49. Eisma R, Wilkinson T (2014) From ‘“Silent Teachers”’ to models. PLoS Biol 12:e1001971

    Article  PubMed  PubMed Central  Google Scholar 

  50. Giger U, Frésard I, Häfliger A, Bergmann M, Krähenbühl L (2008) Laparoscopic training on Thiel human cadavers: a model to teach advanced laparoscopic procedures. Surg Endosc 22:901–906

    Article  PubMed  Google Scholar 

  51. Supe A, Dalvi A, Prabhu R, Kantharia C, Bhuiyan P (2005) Cadaver as a model for laparoscopic training. Indian J Gastroenterol 24:111–113

    PubMed  Google Scholar 

  52. Willaert W, Tozzi F, Van Herzeele I, D’Herde K, Pattyn P (2018) Systematic review of surgical training on reperfused human cadavers. Acta Chir Belg 13:1–11

    Google Scholar 

  53. Balta JY, Cronin M, Cryan JF, O’Mahony SM (2015) Human preservation techniques in anatomy: a 21st century medical education perspective. Clin Anat 28:725–734

    Article  PubMed  Google Scholar 

  54. Chevallier C, Willaert W, Kawa E, Centola M, Steger B, Dirnhofer R, Mangin P, Grabherr S (2014) Postmortem circulation: a new model for testing endovascular devices and training clinicians in their use. Clin Anat 27:556–562

    Article  PubMed  Google Scholar 

  55. Wolff KD, Fichter A, Braun C, Bauer F, Humbs M (2014) Flap raising on pulsatile perfused cadaveric tissue: a novel method for surgical teaching and exercise. J Craniomaxillofac Surg 42:1423–1427

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank the members of the panel of experts for their expertise and the time invested: Adnan Alseidi, Louise Barbier, François Cauchy, Alexis Laurent, and Brice Gayet.

Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Digestive Surgery, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Chemin Des Bourrely, 13015, Marseille, France

    Théophile Guilbaud, Stéphane Berdah, David Jérémie Birnbaum & Laura Beyer Berjot

  2. Center for Surgical Teaching and Research (CERC), Aix-Marseille University, Marseille, France

    Théophile Guilbaud, Stéphane Berdah, David Jérémie Birnbaum & Laura Beyer Berjot

  3. Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, Université Paris Descartes, 42 Boulevard Jourdan, 75014, Paris, France

    David Fuks

Authors
  1. Théophile Guilbaud
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David Fuks
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stéphane Berdah
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. David Jérémie Birnbaum
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Laura Beyer Berjot
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Théophile Guilbaud.

Ethics declarations

Disclosure

Drs Théophile Guilbaud, David Fuks, Stéphane Berdah, David Jérémie Birnbaum, and Laura Beyer Berjot have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Guilbaud, T., Fuks, D., Berdah, S. et al. Development of a novel educational tool to assess skills in laparoscopic liver surgery using the Delphi methodology: the laparoscopic liver skills scale (LLSS). Surg Endosc 36, 2321–2333 (2022). https://doi.org/10.1007/s00464-021-08507-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-021-08507-w

Keywords

Search

Navigation