FLS simulator performance predicts intraoperative laparoscopic skill
- 26 June 2007
- journal article
- research article
- Published by Springer Science and Business Media LLC in Surgical Endoscopy
- Vol. 21 (11), 1991-1995
- https://doi.org/10.1007/s00464-007-9451-1
Abstract
Simulators are being used more and more for teaching and testing laparoscopic skills. However, it has yet to be firmly established that simulator performance reflects operative laparoscopic skill. The study reported here was designed to test the hypothesis that laparoscopic simulator performance predicts intraoperative laparoscopic skill. A review of our prospectively maintained database identified 40 subjects who underwent Fundamentals of Lapraoscopic Surgery (FLS) skills testing and objective intraoperative assessments within the same 6-month period. Subjects consisted of 22 novice (postgraduate year [PGY] 1–2), 10 intermediate (PGY 3–4), and 8 experienced (PGY 5, fellows, and attendings) laparoscopic surgeons. Laparoscopic performance was objectively assessed in the operating room using the previously validated Global Operative Assessment of Laparoscopic Skill (GOALS). Analysis of variance (ANOVA) was used to compare mean FLS scores and mean GOALS scores across experience levels. The relationship between individual FLS scores and GOALS scores was assessed with linear regression analysis. A multivariate analysis evaluated FLS score and surgeon experience as predictors of intraoperative GOALS score. A receiver-operator curve (ROC) was constructed in order to define an FLS cutoff score that predicts intraoperative performance at or above the level of experienced surgeons. Significance was defined as p < 0.05. Mean FLS scores and mean GOALS scores increased with increasing experience. Individual FLS scores correlated significantly with intraoperative GOALS scores (0.77, p < 0.001). Multivariate analysis confirmed that FLS score is an independent predictor of intraoperative GOALS scores. The ROC identified an FLS cutoff score of 70 with optimal sensitivity (91%) and specificity (86%) for predicting a GOALS score at or above the level of experienced surgeons. In this study sample, FLS simulator scores were independently predictive of intraoperative laparoscopic performance as measured by GOALS. More precisely, an FLS cutoff score of 70 optimized sensitivity and specificity for expert intraoperative performance. A larger prospective study is justified to validate these findings.Keywords
This publication has 19 references indexed in Scilit:
- Teaching Surgical Skills — Changes in the WindThe New England Journal of Medicine, 2006
- The examination assessment of technical competence in vascular surgeryBritish Journal of Surgery, 2006
- Laparoscopic Skills Are Improved With LapMentor??? TrainingAnnals of Surgery, 2006
- Laparoscopic skills laboratories: current assessment and a call for resident training standardsThe American Journal of Surgery, 2006
- A global assessment tool for evaluation of intraoperative laparoscopic skillsThe American Journal of Surgery, 2005
- Proving the Value of Simulation in Laparoscopic SurgeryAnnals of Surgery, 2004
- Randomized clinical trial of virtual reality simulation for laparoscopic skills trainingBritish Journal of Surgery, 2003
- Virtual Reality Training Improves Operating Room PerformanceAnnals of Surgery, 2002
- Laparoscopic training on bench models: better and more cost effective than operating room experience?Journal of the American College of Surgeons, 2000
- The effect of practice on performance in a laparoscopic simulatorSurgical Endoscopy, 1998