Background

An objective procedure-specific assessment (OPSA) to unambiguously assess bariatric surgeon skill in a logical, data-driven, and standardized manner was developed based on the twelve consecutive tasks required to complete the jejunojejunostomy (JJ) portion of the Roux-en-Y gastric bypass (RYGB).

Methods

Four board-certified bariatric surgeons completed the OPSA and Global Operative Assessment of Laparoscopic Skills (GOALS) from de-identified videos of 30 consecutive RYGB surgeries. Responses were dichotomized as safe or unsafe (“poor” on OPSA; ≤3 on GOALS).

Results

For the OPSA, lowest percent agreement was noted for clear identification of ligament of Treitz (63.3%) followed by adequate reflection of transverse colon (70.0%), common enterotomy closure of JJ (73.3%), and evaluating integrity of anastomosis (80.0%). Highest percent agreement for GOALS was tissue handling (80.0%) followed by bimanual dexterity (56.7%), depth perception (56.7%), and efficiency (53.3%). Unanimous agreement on safety was highest for stapler use (100%) and lowest for clear identification of ligament of Treitz (80.0%). Twenty procedures had at least one step rated unsafe.

Conclusions

This preliminary evidence indicates the OPSA is a valid measure of safe surgical performance and is more reliably measured than the GOALS.