International Expert Consensus on Precision Anatomy for Minimally Invasive Pancreatoduodenectomy: PAM‐HBP Surgery Project

2021 ◽  
Author(s):  
Yuichi Nagakawa ◽  
Kohei Nakata ◽  
Hitoe Nishino ◽  
Takao Ohtsuka ◽  
Daisuke Ban ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Expert Consensus ◽  
International Expert

scholarly journals 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

2021 ◽  
Author(s):  
Mona W. Schmidt ◽  
Caelan M. Haney ◽  
Karl-Friedrich Kowalewski ◽  
Vasile V. Bintintan ◽  
Mohammed Abu Hilal ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Patient Outcomes ◽  
Technical Skills ◽  
Expert Consensus ◽  
Global Rating Scale ◽  
Global Rating ◽  
Validity Evidence ◽  
International Expert ◽  
Live Animal ◽  
Intestinal Anastomoses

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.

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