Background
There is growing evidence to support the benefits of laparoscopic rectal cancer resection surgery. Outcomes following rectal cancer resection are dependent upon the technical performance of the surgery and vary between surgeons. Valid and reliable assessment tools are needed to enhance training and ensure safe dissemination of laparoscopic rectal cancer surgery.
The aim of this thesis was to develop an assessment tool for objective measurement of technical performance in laparoscopic rectal cancer surgery.
Methods
The work reported in this thesis was carried out between 2012 and 2014. A systematic review of published literature was performed to identify a quality assurance role for objective assessment in randomised controlled trials investigating surgical procedures. Objective Clinical Human Reliability Assessment (OCHRA) was used to produce a quantitative description of procedural errors enacted in a series of rectal cancer resections. A blinded assessor utilised OCHRA to explore the impact of the interval between chemoradiotherapy and surgery upon complexity of surgery within a randomised controlled trial. A combination of qualitative and quantitative methods was used to develop a bespoke assessment tool for laparoscopic rectal surgery.
Results
A structured framework was developed for the integration of objective assessment into quality assurance mechanisms of randomised controlled trials investigating surgical procedures. Error frequencies identified by OCHRA during laparoscopic rectal cancer surgery were found to correlate with other indicators of technical performance and had good test-retest reliability. The interval between chemoradiotherapy and surgery did not significantly impact upon the complexity of surgery. A bespoke assessment tool was developed for expert evaluation of performance, and an exploratory experiment has tested its reliability.
Conclusions
Objective assessment of laparoscopic rectal cancer resection is feasible but complex. Both OCHRA and the assessment tool described in this thesis could be used for such assessment; however larger-scale studies are indicated to further validate these tools.