Development and validation of the objective assessment of robotic suturing and knot tying skills for chicken anastomotic model

Background To improve patient safety, there is an imperative to develop objective performance metrics for basic surgical skills training in robotic surgery. Objective To develop and validate (face, content, and construct) the performance metrics for robotic suturing and knot tying, using a chicken anastomotic model. Design, setting and participants Study 1: In a procedure characterization, we developed the performance metrics (i.e., procedure steps, errors, and critical errors) for robotic suturing and knot tying, using a chicken anastomotic model. In a modified Delphi panel of 13 experts from four EU countries, we achieved 100% consensus on the five steps, 18 errors and four critical errors (CE) of the task. Study 2: Ten experienced surgeons and nine novice urology surgeons performed the robotic suturing and knot tying chicken anastomotic task. The mean inter-rater reliability for the assessments by two experienced robotic surgeons was 0.92 (95% CI, 0.9-0.95). Novices took 18.5 min to complete the task and experts took 8.2 min. (p = 0.00001) and made 74% more objectively assessed performance errors than the experts (p = 0.000343). Conclusions We demonstrated face, content, and construct validity for a standard and replicable basic anastomotic robotic suturing and knot tying task on a chicken model. Patient summary Validated, objective, and transparent performance metrics of a robotic surgical suturing and knot tying tasks are imperative for effective and quality assured surgical training.

Automated summary

In order to improve patient safety, it is crucial to establish objective performance metrics for basic surgical skills training in robotic surgery. By using a chicken anastomotic model, the performance metrics for robotic suturing and knot tying were developed and validated, showing that novices spent more time and made more errors compared to experts in the task.