Laparoscopic Decision Making: Impact of Preoperative Reading and Laparoscopic Experience

Purpose: A competent laparoscopic surgeon requires good technical skills and good surgical judgment. The assessment of technical skills using bench models and simulators has been well studied. However, there has been a paucity of studies examining the cognitive aspects of surgery. We developed a novel tool to assess the procedural knowledge and higher level decision making required for successful laparoscopic nephrectomy. We assessed the effect of laparoscopic experience and the effect of self-preparation or preoperative reading on surgical decision making abilities using a novel assessment tool and methodology. Materials and Methods: A total of 17 novice and advanced urology residents were randomized to preoperative reading or no preoperative reading. Subjects viewed laparoscopic nephrectomy clips and verbalized their thought processes. Their performance was transcribed and blindly rated using a new surgical decision making rating scale. Results: The correlation with overall surgical decision making rating scale score was good for years of training and moderate for the number of laparoscopic cases performed (r = 0.7 and 0.54, respectively, p <0.05). Preoperative reading did not have a significant impact on the overall surgical decision making rating scale score (p >0.05). However, when stratified by laparoscopic experience level (fewer than 10 cases), preoperative reading had a significant impact on the performance of novices with respect to the knowledge components of the procedure but not the judgment domain (each p >0.05). Conclusions: Overall preoperative reading did not improve the surgical decision making rating scale. Novice procedural knowledge benefited from preoperative reading but not surgical judgment. The surgical decision making rating scale appears promising and it may have future implications for assessing surgical competency.