Development and Validation of a Tool for the Evaluation of Laparoscopic Intestinal Anastomosis in Simulation.

Abstract:

INTRODUCTION:Laparoscopic side-to-side intestinal anastomosis is a common in clinic practice and training simulation. The aim of this study is to design and validate a reliable and reproducible tool for its evaluation. METHODS:A modified Delphi method was used to design a tool with elements that determine quality, including 5 items: separation between stiches, eversion, tension, leak and iatrogenesis. The study included 21 participants (10 first-year residents and 11 experts) who performed a 5cm laparoscopic intestinal side-to-side anastomosis with porcine viscera. The evaluations were blinded and done independently by 2 evaluators. RESULTS:The means obtained by novice and expert participants were, respectively: separation between stiches 3.2 vs. 5.7 (P < .001), eversion 3.3 vs. 5.9 (P = .004), tension 2.9 vs. 5.9 (P = .001), leak tightness 3.2 vs. 5.7 (P = .005), iatrogenesis 6.9 vs. 7 (P = .47). The iatrogenesis parameter was not discriminatory, so it was removed from the tool. The total results were 12.5 for novices and 23.2 for experts (P = .001). The correlation between observers presented an intraclass correlation coefficient of 0.99 for the separation between stiches, 0.94 for eversion, 0.98 for tension and 0.99 for leak. The correlation between the score and the leak without pressure presented a Rosenthal's R of -0.71 (P < .001); with pressure R = -0.55 (P = .01). CONCLUSIONS:The designed tool is valid to discriminate between novice and expert participants, presents very high concordance between observers and correlates with the risk of leak.

journal_name

Cir Esp

journal_title

Cirugia espanola

authors

Fernández MJ,Toledo E,Cañón M,Manuel-Palazuelos JC,M Maestre J

doi

10.1016/j.ciresp.2019.10.005

subject

Has Abstract

pub_date

2020-05-01 00:00:00

pages

274-280

issue

5

eissn

0009-739X

issn

1578-147X

pii

S0009-739X(19)30328-8

journal_volume

98

pub_type

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