Abstract
Study 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 <10%.Conclusion: The validity evidence of the H-OSATS rating scale differed for separate evaluations of the 7 tasks. Three tasks(i.e., creation of the bladder flap, colpotomy, and closure of the vault) revealed sound validity evidence, including at thelevel of the attending surgeon, whereas other tasks were more consistent with low-stakes formative evaluation standards.