Performance Assessment for Total Laparoscopic Hysterectomy in the Operating Room: Validity Evidence of a Procedure-specific Rating Scale

International audienceStudy Objective: The technical conduct of total laparoscopic hysterectomy (LH) is critical to surgical outcomes. This studyexplored the validity evidence of an objective scale specific to the assessment of technical skills (H-OSATS) for 7 tasks ofan LH with salpingo-oophorectomy procedure performed in the operating room.Design: Observational cohort study.Setting: Two academic hospitals in Marseille and Montpellier, France.Patients: Three groups of operators (novice, intermediate, and experienced surgeons) were video recorded during their liveperformances of LH on a simple case. For each group, a dozen unedited videos were obtained for the following tasks: divisionof the round ligament, division of the infundibulopelvic ligament, creation of the bladder flap, opening of the posteriorperitoneum, division of the uterine vessels, colpotomy, and closure of the vault.Interventions: Two qualified raters blindly assessed each video using the H-OSATS rating scale. Inter-rater reliability andtest−retest reliability were calculated as measures of internal structure. In a separate round of evaluations, the raters provideda global competent/noncompetent decision for each performance. As a measure of consequential validity, a pass/failscore was set for each task using the contrasting group method.Measurements and Main Results: Three tasks (creation of the bladder flap, colpotomy, and closure of the vault) displayedsound validity evidence: a meaningful total score difference among the 3 groups of experience as well as between the intermediateand experienced surgeons, reliability outcomes of >0.7, and a pass/fail score with a theoretical false-positive rateof