Objective assessment tools in laparoscopic or robotic-assisted gynecological surgery: A systematic review

Freweini Martha Tesfai; Jasleen Nagi; Iona Morrison; Matt Boal; Adeola Olaitan; Dhivya Chandrasekaran; Danail Stoyanov; Anne Lanceley; Nader Francis

doi:10.1111/aogs.14840

Objective assessment tools in laparoscopic or robotic-assisted gynecological surgery: A systematic review

Acta Obstet Gynecol Scand. 2024 Apr 12. doi: 10.1111/aogs.14840. Online ahead of print.

Authors

Freweini Martha Tesfai^{1

2

3}, Jasleen Nagi⁴, Iona Morrison⁵, Matt Boal^{1

2

3}, Adeola Olaitan⁶, Dhivya Chandrasekaran^{2

7}, Danail Stoyanov^{2

3}, Anne Lanceley², Nader Francis^{1

2

5}

Affiliations

¹ The Griffin Institute, Northwick Park & St Marks' Hospital, London, UK.
² EGA Institute for Women's Health, University College London, London, UK.
³ Wellcome/EPSRC Center for Interventional and Surgical Sciences (WEISS), University College London, London, UK.
⁴ Imperial College London, London, UK.
⁵ Yeovil District Hospital, Somerset Foundation NHS Trust, Yeovil, UK.
⁶ The Wellington Hospital, HCA Hospitals, London, UK.
⁷ Department of Gynecological Oncology, University College of London Hospitals, London, UK.

PMID: 38610108
DOI: 10.1111/aogs.14840

Abstract

Introduction: There is a growing emphasis on proficiency-based progression within surgical training. To enable this, clearly defined metrics for those newly acquired surgical skills are needed. These can be formulated in objective assessment tools. The aim of the present study was to systematically review the literature reporting on available tools for objective assessment of minimally invasive gynecological surgery (simulated) performance and evaluate their reliability and validity.

Material and methods: A systematic search (1989-2022) was conducted in MEDLINE, Embase, PubMed, Web of Science in accordance with PRISMA. The trial was registered with the Prospective Register of Systematic Reviews (PROSPERO) ID: CRD42022376552. Randomized controlled trials, prospective comparative studies, prospective single-group (with pre- and post-training assessment) or consensus studies that reported on the development, validation or usage of assessment tools of surgical performance in minimally invasive gynecological surgery, were included. Three independent assessors assessed study setting and validity evidence according to a contemporary framework of validity, which was adapted from Messick's validity framework. Methodological quality of included studies was assessed using the modified medical education research study quality instrument (MERSQI) checklist. Heterogeneity in data reporting on types of tools, data collection, study design, definition of expertise (novice vs. experts) and statistical values prevented a meaningful meta-analysis.

Results: A total of 19 746 titles and abstracts were screened of which 72 articles met the inclusion criteria. A total of 37 different assessment tools were identified of which 13 represented manual global assessment tools, 13 manual procedure-specific assessment tools and 11 automated performance metrices. Only two tools showed substantive evidence of validity. Reliability and validity per tool were provided. No assessment tools showed direct correlation between tool scores and patient related outcomes.

Conclusions: Existing objective assessment tools lack evidence on predicting patient outcomes and suffer from limitations in transferability outside of the research environment, particularly for automated performance metrics. Future research should prioritize filling these gaps while integrating advanced technologies like kinematic data and AI for robust, objective surgical skill assessment within gynecological advanced surgical training programs.

Keywords: minimally invasive gynecological surgery; objective assessment tools; surgical training.

Publication types

Review