Vascular pedicle dissection time in laparoscopic colectomies as a novel marker of surgical skill: a prospective cohort study.

Abstract

Background: Outcomes after colorectal resections depend on patient, pathology and operative factors. Existing validated surgical skills scores (such as the competency assessment tool (CAT)) are directly correlated with outcomes but are time-consuming to administer, limiting their clinical utility. The vascular pedicle dissection time (VPDT) is a novel, simple surgical skill assessment measure with the potential for computer vision automation. This study aimed to assess the VPDT and benchmark it against the CAT score.

Methods: A prospective multicentre study was performed in New Zealand, recording videos of laparoscopic colorectal resections. Patient, operation and histology characteristics were also collected. The VPDT was calculated from retraction of the vascular pedicle to completion of medial dissection, including vascular division. Each laparoscopic video was scored by two independent colorectal surgeons, and the median CAT score was grouped into tertiles.

Results: In total, 154 patients were included between December 2020 and November 2023 (74 (48.1%) right-sided and 80 (51.9%) left-sided resections). Median VPDT was significantly different between the CAT score groups for the right-sided resections (lower, 15 min; middle, 13 min; higher, 10 min; p = 0.036) and the left-sided resections (lower, 46 min; middle, 40 min; higher, 26 min; p =  < 0.001). There was no significant difference in R1 resection, anastomotic leak rate, the occurrence of Clavien-Dindo > 3 complications or re-admission between the CAT groups.

Conclusions: This study showed that the VPDT was inversely correlated with the CAT score, indicating that it quantifies operative technical skill. A current study is evaluating the suitability of VPDT for real-time measurement using computer vision algorithms. This could allow for automated assessment of surgeons' learning curve and skills.