Development and validity evidence of an objective structured assessment of technical skills score for minimally invasive linear-stapled, hand-sewn intestinal anastomoses: the A-OSATS score

Mona W Schmidt; Caelan M Haney; Karl-Friedrich Kowalewski; Vasile V Bintintan; Mohammed Abu Hilal; Alberto Arezzo; Marcus Bahra; Marc G Besselink; Matthias Biebl; Luigi Boni; Michele Diana; Jan H Egberts; Lars Fischer; Nader Francis; Daniel A Hashimoto; Daniel Perez; Marlies Schijven; Moritz Schmelzle; Marek Soltes; Lee Swanstrom; Thilo Welsch; Beat P Müller-Stich; Felix Nickel

doi:10.1007/s00464-021-08806-2

Development and validity evidence of an objective structured assessment of technical skills score for minimally invasive linear-stapled, hand-sewn intestinal anastomoses: the A-OSATS score

Surg Endosc. 2022 Jun;36(6):4529-4541. doi: 10.1007/s00464-021-08806-2. Epub 2021 Nov 9.

Authors

Mona W Schmidt^{1

2}, Caelan M Haney^{1

3}, Karl-Friedrich Kowalewski^{1

4}, Vasile V Bintintan⁵, Mohammed Abu Hilal^{6

7}, Alberto Arezzo⁸, Marcus Bahra⁹, Marc G Besselink¹⁰, Matthias Biebl¹¹, Luigi Boni¹², Michele Diana^{13

14

15

16}, Jan H Egberts¹⁷, Lars Fischer¹⁸, Nader Francis¹⁹, Daniel A Hashimoto²⁰, Daniel Perez²¹, Marlies Schijven²², Moritz Schmelzle¹¹, Marek Soltes²³, Lee Swanstrom¹⁴, Thilo Welsch²⁴, Beat P Müller-Stich¹, Felix Nickel²⁵

Affiliations

¹ Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
² Department of Gynecology and Obstetrics, University Medical Centre Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
³ Department of Urology, University Hospital Leipzig, Liebigstraße 20, Haus 4, 04103, Leipzig, Germany.
⁴ Department of Urology and Urological Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
⁵ Department of Surgery, 1st Surgical Clinic, University of Medicine and Pharmacy, Cluj Napoca, Romania.
⁶ Department of Surgery, Hepatobiliary Pancreatic and Minimally Invasive Unit, Poliambulanza Foundation Hospital, Brescia, Italy.
⁷ Department of Surgery, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK.
⁸ Department of Surgical Sciences, University of Torino, Turin, Italy.
⁹ Department of Surgical Oncology and Robotics, Waldfriede Hospital, Berlin, Germany.
¹⁰ Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
¹¹ Department of Surgery, Charité-Universitätsmedizin Berlin, Campus Charité Mitte/Campus Virchow Klinikum, Berlin, Germany.
¹² Fondazione IRCCS-Ca`Granda - Ospedale Maggiore Policlinico di Milano, University of Milan, Milan, Italy.
¹³ IRCAD Research Institute Against Digestive Cancer, Strasbourg, France.
¹⁴ IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France.
¹⁵ Department of General, Digestive, and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France.
¹⁶ ICube Lab, Photonics for Health, University of Strasbourg, Strasbourg, France.
¹⁷ Department of General, Visceral, Thoracic, Transplantation and Pediatric Surgery, Kurt Semm Center for Minimally Invasive and Robotic Surgery, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany.
¹⁸ Department of Surgery, Hospital Mittelbaden, Baden-Baden, Germany.
¹⁹ Department of Colorectal Surgery, Yeovil District Hospital Foundation Trust, Yeovil, UK.
²⁰ Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
²¹ Department of General, Visceral, and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
²² Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, the Netherlands.
²³ 1St Department of Surgery, University of Pavol Jozef Safarik, Košice, Slovakia.
²⁴ Department of Visceral, Thoracic, and Vascular Surgery, Medical Faculty, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307, Dresden, Germany.
²⁵ Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany. felix.nickel@med.uni-heidelberg.de.

Abstract

Introduction: The aim of this study was to develop a reliable objective structured assessment of technical skills (OSATS) score for linear-stapled, hand-sewn closure of enterotomy intestinal anastomoses (A-OSATS).

Materials and methods: The Delphi methodology was used to create a traditional and weighted A-OSATS score highlighting the more important steps for patient outcomes according to an international expert consensus. Minimally invasive novices, intermediates, and experts were asked to perform a minimally invasive linear-stapled intestinal anastomosis with hand-sewn closure of the enterotomy in a live animal model either laparoscopically or robot-assisted. Video recordings were scored by two blinded raters assessing intrarater and interrater reliability and discriminative abilities between novices (n = 8), intermediates (n = 24), and experts (n = 8).

Results: The Delphi process included 18 international experts and was successfully completed after 4 rounds. A total of 4 relevant main steps as well as 15 substeps were identified and a definition of each substep was provided. A maximum of 75 points could be reached in the unweighted A-OSATS score and 170 points in the weighted A-OSATS score respectively. A total of 41 anastomoses were evaluated. Excellent intrarater (r = 0.807-0.988, p < 0.001) and interrater (intraclass correlation coefficient = 0.923-0.924, p < 0.001) reliability was demonstrated. Both versions of the A-OSATS correlated well with the general OSATS and discriminated between novices, intermediates, and experts defined by their OSATS global rating scale.

Conclusion: With the weighted and unweighted A-OSATS score, we propose a new reliable standard to assess the creation of minimally invasive linear-stapled, hand-sewn anastomoses based on an international expert consensus. Validity evidence in live animal models is provided in this study. Future research should focus on assessing whether the weighted A-OSATS exceeds the predictive capabilities of patient outcomes of the unweighted A-OSATS and provide further validity evidence on using the score on different anastomotic techniques in humans.

Keywords: Anastomosis; Delphi method; Minimally invasive surgery; OSATS; Skill assessment.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Anastomosis, Surgical / methods
Animals
Clinical Competence*
Digestive System Surgical Procedures*
Humans
Reproducibility of Results
Video Recording