Objective metrics for hand-sewn bowel anastomoses can differentiate novice from expert surgeons

Ganesh Sankaranarayanan, Lisa M. Parker, Aimal Khan, James Dials, Doga Demirel, Tansel Halic, Alyson Crawford, Uwe Kruger, Suvranu De, James W. Fleshman

Research output: Contribution to journalArticlepeer-review


Background: Assessing performance automatically in a virtual reality trainer or from recorded videos is advantageous but needs validated objective metrics. The purpose of this study is to obtain expert consensus and validate task-specific metrics developed for assessing performance in double-layered end-to-end anastomosis. Materials and methods: Subjects were recruited into expert (PGY 4–5, colorectal surgery residents, and attendings) and novice (PGY 1–3) groups. Weighted average scores of experts for each metric item, completion time, and the total scores computed using global and task-specific metrics were computed for assessment. Results: A total of 43 expert surgeons rated our task-specific metric items with weighted averages ranging from 3.33 to 4.5 on a 5-point Likert scale. A total of 20 subjects (10 novices and 10 experts) participated in validation study. The novice group completed the task significantly more slowly than the experienced group (37.67 ± 7.09 vs 25.47 ± 7.82 min, p = 0.001). In addition, both the global rating scale (23.47 ± 4.28 vs 28.3 ± 3.85, p = 0.016) and the task-specific metrics showed a significant difference in performance between the two groups (38.77 ± 2.83 vs 42.58 ± 4.56 p = 0.027) following partial least-squares (PLS) regression. Furthermore, PLS regression showed that only two metric items (Stay suture tension and Tool handling) could reliably differentiate the performance between the groups (20.41 ± 2.42 vs 24.28 ± 4.09 vs, p = 0.037). Conclusions: Our study shows that our task-specific metrics have significant discriminant validity and can be used to evaluate the technical skills for this procedure.

Original languageEnglish (US)
Pages (from-to)1282-1292
Number of pages11
JournalSurgical endoscopy
Issue number2
StatePublished - Feb 2023

ASJC Scopus subject areas

  • Surgery


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