Journal article
Using video-based assessment (VBA) to document fellow improvement in safely completing the jejunojejunostomy portion of laparoscopic Roux-en-Y gastric bypass (RYGB) surgery
Surgical endoscopy, Vol.37(11), pp.8853-8860
11/2023
DOI: 10.1007/s00464-023-10425-y
PMID: 37759145
Abstract
BACKGROUNDSurgical assessment instruments are used for formative and summative trainee evaluations. To characterize the features of existing instruments and a novel 12-item objective, procedure-specific assessment tool for Roux-en-Y Gastric Bypass (RYGB-OPSA), we evaluated the progress of a single surgical fellow over 17 consecutive surgeries. METHODSSeventeen consecutive RYGB videos completed between 8/2021 and 1/2022 by an academic hospital surgical fellow were de-identified and assessed by four board-certified bariatric surgeons using Global Operative Assessment of Laparoscopic Skills (GOALS), General Assessment of Surgical Skill (GASS), and RYGB-OPSA which includes the reflection of transverse colon, identification of ligament of Treitz, biliopancreatic and Roux limbs orientation, jejunal division point selection, stapler use, mesentery division, bleeding control, jejunojejunostomy (JJ) anastomotic site selection, apposition of JJ anastomotic site, JJ creation, common enterotomy closure of JJ, and integrity of anastomosis. The GASS measured economy of motion, tissue handling, appreciating operative anatomy, bimanual dexterity, and achievement of hemostasis. RYGB-OPSA and GASS items were scored "poor-unsafe," "acceptable-safe," or "good-safe." Change in performance was measured by linear trendline slope. RESULTSOver the course of 17 procedures, significant improvement was demonstrated by three GOALS items, GOALS overall score, GASS bimanual dexterity, and three RYGB-OPSA tasks: JJ creation, jejunal division point selection, and stapler use. Achievement of hemostasis declined but never rated "poor-unsafe." Overall RYGB-OPSA and GOALS trendlines documented significant increase across the 17 procedures. CONCLUSIONThis examination of a bariatric surgery fellow's operative training experience as measured by three surgical assessment instruments demonstrated anticipated improvements in general skills and safe completion of procedure-specific tasks. Effective surgical assessment instruments have enough sensitivity to show improvement to enable meaningful trainee feedback (low-stakes assessments) as well as the ability to determine safe surgical practice to enable promotion to greater autonomous practice.
Details
- Title: Subtitle
- Using video-based assessment (VBA) to document fellow improvement in safely completing the jejunojejunostomy portion of laparoscopic Roux-en-Y gastric bypass (RYGB) surgery
- Creators
- Peter Nau - University of IowaErin Worden - University of Iowa Hospitals and ClinicsRyan Lehmann - University of IowaKyle Kleppe - University of Tennessee at KnoxvilleGregory J Mancini - University of Tennessee at KnoxvilleMatt L Mancini - University of Tennessee at KnoxvilleBruce Ramshaw - HealthInsightMichael S Woods - IDEX Corporation
- Resource Type
- Journal article
- Publication Details
- Surgical endoscopy, Vol.37(11), pp.8853-8860
- DOI
- 10.1007/s00464-023-10425-y
- PMID
- 37759145
- ISSN
- 0930-2794
- eISSN
- 1432-2218
- Grant note
- name: Caresyntax Corporation
- Language
- English
- Electronic publication date
- 09/27/2023
- Date published
- 11/2023
- Academic Unit
- Surgery
- Record Identifier
- 9984473768302771
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