An objective scoring system for laparoscopic cholecystectomy

Background: Direct observation with structured criteria for performance is the most reliable and valid method of assessing technical skill during oper ative procedures. We developed such a system to evaluate technical performa nce during a laparoscopic cholecystectomy. The reliability and validity of the system were tested by analyzing the correlation among three observers i n a multicenter study and comparing performance with years of surgical expe rience. Study Design: Thirty consecutive cases of laparoscopic cholecystectomy were recorded on videotape, 10 from each of 3 institutions. Independent scores were generated by three observers examining each of the videotapes, providi ng a total of 90 scores. Points were awarded for successful completion of e ach of 23 different steps required to perform a laparoscopic cholecystectom y. Error points were tabulated based on the frequency and relative severity of each of 21 potential technical mistakes during the operation. The final score was assumed to be a relative measure of technical skill and was deri ved by subtracting error points from points awarded for completion of each step of the procedure. Pearson correlation coefficients were used to assess agreement among examiners and correlation with year of surgical experience . Results: Agreement in final scores among the three observers was excellent (r = 0.74-0.96) despite the fact that one observer assigned significantly f ewer error points. Correlation between year of experience and two-handed te chnique scoring was good (r = 0.5, p = 0.057), but the correlation between experience and one-handed technique scores was poor (r = 0.02). Conclusions: The technical skills required to perform laparoscopic cholecys tectomy can reliably be measured using this tool. This method can be used t o track the learning curve of surgeons in training, evaluate the efficacy o f alternative training tools, and provide a means of self-assessment for th e trainee. (J Am Coll Surg 1999; 189:566-574. (C) 1999 by the American Coll ege of Surgeons).