Targeted surgical coaching can improve operative self-assessment ability: A single-blinded nonrandomized trial.

BACKGROUND: The aim of the study was to investigate the effect of targeted surgical coaching on self-assessment of laparoscopic operative skill. Accurate self-assessment is vital for autonomous professional development. Surgical coaching can be used for performance improvement, but its role in this domain has been insufficiently investigated. METHODS: This was a single site, nonrandomized, interrupted time series design trial. Participants were residents, fellows, and attending surgeons regularly performing laparoscopic general surgery operations. Each participant was enrolled in an individualized coaching program using review of personal and peer laparoscopic videos. The program involved 3 to 5 sessions over a period of 6 to 19 weeks. Coaching used case debriefing to target self-assessment proficiency, with a focus on objective interpretation of observations and facilitative capacity building. The primary outcome measure was self-assessment accuracy and correlation to expert ratings. The Objective Structured Assessment of Technical Skill global rating scale was utilized for evaluation. RESULTS: Twelve participants were recruited and completed the coaching program. At baseline, there was no correlation between self-assessment and expert ratings. After completion of the coaching program there was correlation between self-assessment and expert ratings (P = .003) and improved self-assessment accuracy compared to baseline (P = .041). CONCLUSION: This study has demonstrated that targeted coaching using video review of laparoscopic cases can improve operative self-assessment accuracy using the Objective Structured Assessment of Technical Skill.

Reformed gallbladder after laparoscopic subtotal cholecystectomy: correlation of surgical findings with ultrasound and CT imaging†.

Laparoscopic subtotal cholecystectomy is a technique that is becoming increasingly prevalent in modern surgery. It avoids the cystic duct and artery where acute or chronic cholecystitis prevents a safe laparoscopic dissection of these structures. There are numerous reports of symptomatic cystic duct remnants after subtotal cholecystectomy in the literature on post-cholecystectomy syndrome. We present a case report of a 62-year-old man who underwent emergent laparoscopic subtotal cholecystectomy complicated by the development of a persistent, controlled bile leak. This was followed on serial ultrasound examinations and managed with multiple drain insertions and endoscopic retrograde cholangiopancreatography. The patient represented 4 months later with right upper quadrant pain and was found to have an apparently normal gallbladder on CT abdomen. Repeat laparoscopic cholecystectomy demonstrated a reformed gallbladder wall and was completed in the standard fashion. This case demonstrates an unexpected complication of laparoscopic cholecystectomy with correlation of radiological and surgical findings.