评估一种用于内镜子宫切除术手术复杂性评估的新型评分工具的评分者和评分者的可靠性。
验证研究。
学术医学中心。
共有11名妇产科医生,接受不同年份的住院医师培训,临床实践,和手术量。
应用一种新颖的评分工具,以评估手术干预前以标准化方式拍摄的150组图像的手术复杂性(全球骨盆,前死胡同,后死胡同,右附件,左附件)。仅使用这些图像,评估者被要求评估子宫大小,number,和肌瘤的位置,附件和子宫活动,需要输尿管溶解术,以及相关部位存在子宫内膜异位症或粘连。手术复杂性按1至4的等级进行(从低到高复杂性)。
参与手术的外科医生的实习后年限为2至15年,平均为8年。共有8名妇产科医生(72.7%)完成了微创妇科手术的研究金。6例(54.6%)报告年子宫切除术数量>50例。Raters报告说,95.4%的图像对评估令人满意。在150组图像中,大多数被发现是第1至第2阶段的复杂性(第1阶段:23.8%,第二阶段:41.6%,第三阶段:32.8%,阶段4:1.8%)。评估者之间关于阶段1至2和3至4复杂性的一致性水平中等(κ=0.49;95%置信区间[CI],0.42-0.56)。在每年子宫切除术量>50的外科医生评估者之间(κ=0.49;95%CI,0.40-0.57)以及具有研究经验的外科医生评估者之间(κ=0.50;95%CI,0.42-0.58)也发现了中等评估者之间的协议。所有评估者的内部一致性平均为80.2%,也达到了中等一致性(平均加权κ=0.53;范围,0.38-0.72)。
这种新颖的评分工具使用介入前解剖图像的临床评估来对内镜子宫切除术的手术复杂性进行分层。它具有丰富而全面的评估能力,并实现了适度的评估者之间和内部协议。该工具可以与手术复杂性的传统标记物(例如子宫重量)结合使用或代替。估计失血量,和手术时间。
Evaluate inter-rater and intrarater reliability of a novel scoring tool for surgical complexity assessment of endoscopic hysterectomy.
Validation study.
Academic medical center.
Total of 11 academic obstetrician-gynecologists with varying years of postresidency training, clinical practice, and surgical volumes.
Application of a novel scoring tool to evaluate surgical complexity of 150 sets of images taken in a standardized fashion before surgical intervention (global pelvis, anterior cul-de-sac, posterior cul-de-sac, right adnexa, left adnexa). Using only these images, raters were asked to assess uterine size, number, and location of myomas, adnexal and uterine mobility, need for ureterolysis, and presence of endometriosis or adhesions in relevant locations. Surgical complexity was staged on a scale of 1 to 4 (low to high complexity).
Number of postresidency years in practice for participating surgeons ranged from 2 to 15, with an average of 8 years. A total of 8 obstetrician-gynecologists (72.7%) had completed a fellowship in minimally invasive gynecologic surgery. Six (54.6%) reported an annual volume of >50 hysterectomies. Raters reported that 95.4% of the images were satisfactory for assessment. Of the 150 sets of images, most were found to be stage 1 to 2 complexity (stage 1: 23.8%, stage 2: 41.6%, stage 3: 32.8%, stage 4: 1.8%). The level of inter-rater agreement regarding stage 1 to 2 vs 3 to 4 complexity was moderate (κ = 0.49; 95% confidence interval [CI], 0.42-0.56). Moderate inter-rater agreement was also found between surgeon raters with an annual hysterectomy volume >50 (κ = 0.49; 95% CI, 0.40-0.57) as well as between surgeon raters with fellowship experience (κ = 0.50; 95% CI, 0.42-0.58). Intrarater agreement averaged 80.2% among all raters and also achieved moderate agreement (mean weighted κ = 0.53; range, 0.38-0.72).
This novel scoring tool uses clinical assessment of preintervention anatomic images to stratify the surgical complexity of endoscopic hysterectomy. It has rich and comprehensive evaluation capabilities and achieved moderate inter-rater and intrarater agreement. The tool can be used in conjunction with or instead of traditional markers of surgical complexity such as uterine weight, estimated blood loss, and operative time.