Objective Assessment of Laparoscopist Performance and Its Relationship with Intraoperative Technical Errors in Pediatric Laparoscopic Inguinal Hernia Repair: A Retrospective Observational Study.

BACKGROUND

Although camera navigation is integral to pediatric endoscopic surgery, no validated framework exists for assessing laparoscopist performance. This study evaluated the validity of a modified Objective Structured Assessment of Camera Navigation Skills (OSA-CNS) and investigated how laparoscopist performance influenced procedural safety.

METHODS

This retrospective study evaluated unilateral single-incision laparoscopic percutaneous extraperitoneal closure (SILPEC) procedures performed in males at our institution between January and December 2022. Laparoscopist performance was assessed using a modified OSA-CNS. Two blinded raters independently scored surgical videos to evaluate inter-rater reliability and internal consistency. Technical errors and events were obtained from previous studies using the Generic Error Rating Tool. Modified OSA-CNS scores were compared using the Kruskal-Wallis test. The associations of laparoscopist performance with errors, events, and procedure time were analyzed using surgeon-clustered linear regression.

RESULTS

Briefly, 25 unilateral procedures with 185 errors and 40 events were included. The median procedure time was 23.3 (20.3-29.4) min. The modified OSA-CNS demonstrated excellent inter-rater reliability (intraclass correlation coefficient = 0.96) and internal consistency (Cronbach's α = 0.88-0.91). It distinguished performance across laparoscopists with differing experiences (P = .0020). Higher laparoscopist scores were associated with fewer errors (β = -0.19, 95% CI: -0.34 to -0.04; P = .025) but not with event counts or procedure time.

CONCLUSIONS

The modified OSA-CNS is reliable and valid for evaluating laparoscopist performance in pediatric SILPEC. Its ability to reflect skill differences and its association with error frequency underscore its value in surgical education and intraoperative safety improvement.