Competence Assessment Tool for Laparoscopic Supracervical Hysterectomy (CAT-LSH)
Goderstad et al.21 developed CAT-LSH, a procedure-specific rating tool for laparoscopic supracervical hysterectomy and compared it with Global Operative Assessment of Laparoscopic Skills (GOALS) 22, a general rating scale. GOALS has been validated for laparoscopic ventral hernia repair, laparoscopic appendectomy, laparoscopic inguinal hernia and laparoscopic and open cholecystectomy.4
By defining the main steps of the hysterectomy procedure, CAT-LSH assesses ligament mobilisation, release of adnexa form uterus, division of uterine vessels and uterus amputation. Each step evaluates the use of instruments, tissue handling and errors, with a maximum of 16 points assigned per step for a total possible score of 64. The procedure was recorded, and the performing surgeon was evaluated by both the operating assistant and by blinded reviewers on video footage. Twenty-one doctors performed 37 procedures eligible for blinded assessment.
The study found that GOALS allowed blinded observers to differentiate between inexperienced and intermediate experienced surgeons, but not between intermediate experienced surgeons compared to expert surgeons (p=0.085). When performed by the assistant surgeon, the GOALS assessment differed significantly between the three groups. When the assistant surgeon performed assessments using CAT-LSH, it was able to discriminate between inexperienced and intermediate experienced surgeons (p=0.001) and intermediate experienced surgeons and experts (p=0.001), demonstrating a significant discriminative validity. The interrater reliability comparing the mean scores for CAT-LSH and GOALS showed good agreement with an ICC>0.75. The study concluded that CAT-LSH has construct validity and is feasible in live surgical assessment with a significant discriminative validity.