Assessment of Surgical Competence: Development and Validation of Rating Scales Used for Laparoscopic Supracervical Hysterectomy

Objective: To develop a procedure-specific rating scale for laparoscopic supracervical hysterectomy (LSH), and to compare the construct validity and reliability with a general rating scale in laparoscopic surgery, global operative assessment of laparoscopic skills (GOALS).

Design: Prospective interobserver study. In collaboration with an expert group, we developed the procedure-specific rating scale, competence assessment tool for laparoscopic supracervical hysterectomy (CAT-LSH). LSH was performed by gynecologists with different levels of surgical competence levels (13 procedures were performed by inexperienced trainees, 13 by intermediate experienced, and 15 by laparoscopic experts). All procedures were video-recorded. Surgical performance was evaluated in all procedures using both CAT-LSH and GOALS by the surgical assistant, as well as by 2 blinded observers evaluating the video recordings.

Setting: University teaching hospital.

Participants: Laparoscopic experts, consultants and gynecological registrars from the Department of Gynecology.

Results: There were significant differences between the 3 proficiency groups in both the rating scales. Mean GOALS score evaluated by the operating assistant and the 2 observers were for inexperienced surgeons 16.4 vs. 13.6 (p < 0.01), for surgeons with intermediate experienced 22.6 vs. 19.5 (p < 0.05) and for expert surgeons 26.1 vs. 22.4 (p < 0.01), respectively. Corresponding results for the CAT-LSH scores were 41.0/34.6 (p < 0.01), 49.2/43.1 (p < 0.01), and 58.7/51.1 (p < 0.01), respectively. The interrater reliability measured by the interclass correlation coefficient between the surgical assistant and the 2 blinded observers for GOALS and CAT-LSH were 0.71 and 0.75, respectively.

Conclusions: The GOALS and CAT-LSH appear to have construct validity and high interrater reliability. Assessment of surgical competence during LSH is feasible in daily practice with objective rating scales like CAT-LSH and GOALS.