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.