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Tesfai FM, Nagi J, Morrison I, Boal M, Olaitan A, Chandrasekaran D, Stoyanov D, Lanceley A, Francis N. Objective assessment tools in laparoscopic or robotic-assisted gynecological surgery: A systematic review. Acta Obstet Gynecol Scand 2024. [PMID: 38610108 DOI: 10.1111/aogs.14840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/28/2024] [Accepted: 03/19/2024] [Indexed: 04/14/2024]
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.
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Affiliation(s)
- Freweini Martha Tesfai
- The Griffin Institute, Northwick Park & St Marks' Hospital, London, UK
- EGA Institute for Women's Health, University College London, London, UK
- Wellcome/EPSRC Center for Interventional and Surgical Sciences (WEISS), University College London, London, UK
| | | | - Iona Morrison
- Yeovil District Hospital, Somerset Foundation NHS Trust, Yeovil, UK
| | - Matt Boal
- The Griffin Institute, Northwick Park & St Marks' Hospital, London, UK
- EGA Institute for Women's Health, University College London, London, UK
- Wellcome/EPSRC Center for Interventional and Surgical Sciences (WEISS), University College London, London, UK
| | | | - Dhivya Chandrasekaran
- EGA Institute for Women's Health, University College London, London, UK
- Department of Gynecological Oncology, University College of London Hospitals, London, UK
| | - Danail Stoyanov
- EGA Institute for Women's Health, University College London, London, UK
- Wellcome/EPSRC Center for Interventional and Surgical Sciences (WEISS), University College London, London, UK
| | - Anne Lanceley
- EGA Institute for Women's Health, University College London, London, UK
| | - Nader Francis
- The Griffin Institute, Northwick Park & St Marks' Hospital, London, UK
- EGA Institute for Women's Health, University College London, London, UK
- Yeovil District Hospital, Somerset Foundation NHS Trust, Yeovil, UK
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De Wilde RL, Herrmann A. Robotic surgery - advance or gimmick? Best Pract Res Clin Obstet Gynaecol 2013; 27:457-69. [PMID: 23357200 DOI: 10.1016/j.bpobgyn.2012.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 12/14/2012] [Indexed: 12/15/2022]
Abstract
Robotic surgery is increasingly implemented as a minimally invasive approach to a variety of gynaecological procedures. The use of conventional laparoscopy by a broad range of surgeons, especially in complex procedures, is hampered by several drawbacks. Robotic surgery was created with the aim of overcoming some of the limitations. Although robotic surgery has many advantages, it is also associated with clear disadvantages. At present, the proof of superiority over access by laparotomy or laparoscopy through large randomised- controlled trials is still lacking. Until results of such trials are present, a firm conclusion about the usefulness of robotic surgery cannot be drawn. Robotic surgery is promising, making the advantages of minimally invasive surgery potentially available to a large number of surgeons and patients in the future.
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Affiliation(s)
- Rudy L De Wilde
- Pius-Hospital, Department of Obstetrics, Gynecology and Gynecological Oncology, Carl-von-Ossietzky-University, Georgstraβe 12, 26121 Oldenburg, Germany.
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Hirschelmann A, De Wilde RL. Plastic and reconstructive uterus operations by minimally invasive surgery? A review on myomectomy. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2012; 1:Doc09. [PMID: 26504693 PMCID: PMC4582479 DOI: 10.3205/iprs000009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Plastic and reconstructive uterus operations are performed in congenital uterine anomalies or benign uterine conditions. Congenital uterine anomalies are relatively rare diseases with various approaches for surgical treatment. Therefore, to address the question of the usefulness of a minimally invasive approach in plastic uterus operations, the most common uterine condition which requires reconstructive surgery, namely myomectomy, is discussed. METHOD Searches were conducted in PubMed and The Cochrane Library to identify relevant literature. FINDINGS Compared with myomectomy by laparotomy and minilaparotomy, laparoscopic myomectomy is associated with improved short-term outcomes. Laparoscopy is further associated with less adhesion formation. Pregnancy rates after myomectomy in symptomatic patients might be higher after laparoscopy than after laparotomy. Although uterine ruptures following laparoscopic myomectomy are described in the literature, it seems to be a rare event. Concerning the recurrence, there is evidence that rates are similar after laparoscopy and laparotomy. CONCLUSION Myomectomy by laparoscopy has several advantages over abdominal myomectomy (by conventional laparotomy and minilaparotomy) and should be the standard procedure. Despite the advantages of laparoscopy, abdominal myomectomy is still a frequently performed procedure. Lack of training in advanced laparoscopic procedures hampers the wide-spread use of laparoscopic myomectomy. Due to the advantages of laparoscopic surgery, efforts should be made to implement this procedure into daily practice. To provide the best care, physicians should offer patients the opportunity of a laparoscopic treatment of myomas.
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Affiliation(s)
- Anja Hirschelmann
- Pius-Hospital Oldenburg, Klinik für Frauenheilkunde, Geburtshilfe und Gynäkologische Onkologie, Oldenburg, Germany
| | - Rudy Leon De Wilde
- Pius-Hospital Oldenburg, Klinik für Frauenheilkunde, Geburtshilfe und Gynäkologische Onkologie, Oldenburg, Germany
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