Development of a technical checklist for the assessment of suturing in robotic simulation
With the increased use of simulation for surgical training, there is a need for objective forms of assessment to evaluate trainees. The Global Evaluative Assessment of Robotic Skills (GEARS) is the gold standard for assessing skills in robotic surgery, but there are no recognised checklist scoring systems. The purpose of this study was to develop and validate a checklist for evaluating suturing in robotic surgery.
A suturing checklist, containing needle driving and knot tying categories, was constructed following evaluation of participants performing urethrovesical anastomoses. Key procedural steps were identified from a review of expert surgeons, while assessing novice participants allowed identification of common technical errors. Using the checklist, 22 novices and 13 experts were marked in needle driving, while 18 novices and 10 experts were assessed in knot tying. All participants were scored separately by the GEARS score. Cronbach&[prime]s alpha measured the internal consistency of the checklist, and poorly correlating items were removed based on an increase in internal consistency and following agreement with authors. A Mann-Whitney U test assessed construct validity, and Spearman&[prime]s rank correlation evaluated concurrent validity.
46 items were recorded in the preliminary checklist. The internal consistency of the checklist was strong (Cronbach&[prime]s alpha = 0.870 for needle driving items and 0.736 for knot tying items), and after removal of poorly correlating items, the final checklist contained 32 items (Table 1). Both the needle driving and knot tying categories significantly discriminated between novices and experts (p < 0.005). While the GEARS score demonstrated construct validity for needle driving, it could not significantly differentiate between novices and experts for knot tying (p = 0.286). The needle driving category significantly correlated with the corresponding GEARS scores (rs = 0.613, p < 0.005), but the correlation for knot tying was insignificant (rs = 0.296, p = 0.127).
This study reports the development of a new assessment tool for suturing in robotic surgery, and demonstrates both reliability and validity. Given that checklists are simple to use and may be used accurately by non-experts, there is significant scope for this checklist to be used in surgical training.