Development and validation of the objective assessment of robotic suturing and knot tying skills for chicken anastomotic model

Surg Endosc. 2021 Aug;35(8):4285-4294. doi: 10.1007/s00464-020-07918-5. Epub 2020 Aug 28.


Background: To improve patient safety, there is an imperative to develop objective performance metrics for basic surgical skills training in robotic surgery.

Objective: To develop and validate (face, content, and construct) the performance metrics for robotic suturing and knot tying, using a chicken anastomotic model.

Design, setting and participants: Study 1: In a procedure characterization, we developed the performance metrics (i.e., procedure steps, errors, and critical errors) for robotic suturing and knot tying, using a chicken anastomotic model. In a modified Delphi panel of 13 experts from four EU countries, we achieved 100% consensus on the five steps, 18 errors and four critical errors (CE) of the task. Study 2: Ten experienced surgeons and nine novice urology surgeons performed the robotic suturing and knot tying chicken anastomotic task. The mean inter-rater reliability for the assessments by two experienced robotic surgeons was 0.92 (95% CI, 0.9-0.95). Novices took 18.5 min to complete the task and experts took 8.2 min. (p = 0.00001) and made 74% more objectively assessed performance errors than the experts (p = 0.000343).

Conclusions: We demonstrated face, content, and construct validity for a standard and replicable basic anastomotic robotic suturing and knot tying task on a chicken model. Validated, objective, and transparent performance metrics of a robotic surgical suturing and knot tying tasks are imperative for effective and quality assured surgical training.

Keywords: Face; Proficiency-based metrics; Surgical training; content and construct validation.

MeSH terms

  • Animals
  • Chickens*
  • Clinical Competence
  • Humans
  • Reproducibility of Results
  • Robotic Surgical Procedures*
  • Suture Techniques