Enhancing Surgical Performance: The Need for a Holistic View on Surgical Skills

OBJECTIVE: Recent studies suggest surgeons rely on both technical (TS) and nontechnical (NTS) skills simultaneously, while others have suggested interdependence of the skills. On a practical level, a correlation between the skillsets is yet to be established. The present study investigates whether a relationship between TS and NTS exists on an overall level and on the level of the individual operating room (OR) team. DESIGN: This cross-sectional single cohort simulation-based study took place during 3-days of laparoscopic interventions. Laparoscopic and OR video recordings were obtained during the interventions. Objective Structured Assessment of Technical Skills (OSATS) and Nontechnical Skills for Surgeons (NOTSS) scores focusing on the operating surgeons were subsequently assigned, and Pearson's correlation analyses were performed to assess the association between skill sets. SETTING: The intervention took place at the surgical laboratory facilities for animal research at Aarhus University Hospital. PARTICIPANTS: Three surgical teams participated in the study. Each team consisted of 2 OR nurses and 2 surgeons in post graduate year 3 to 5 undergoing specialist training. Participants of each team were recruited from separate sites across the Central Denmark Region. RESULTS: A total 27 operations were carried out, resulting in 63 recordings that were sent for evaluation. Overall, a weak positive correlation (r = 0.336, p < 0.05) was found between OSATS and NOTSS scores. One team showed a moderate positive correlation (r = 0.497 p < 0.05), while correlations for the other teams were nonsignificant (r = 0.338 p = 0.218), and nonlinear (r = -0.036 p = 0.872), respectively. CONCLUSIONS: This study demonstrated an overall relationship between TS and NTS for surgeons during laparoscopic surgery in a simulated setting. The correlation on team level was inconsistent, indicating the dynamics of the individual teams may be of essence. A holistic view on surgical skills may be crucial in enabling surgeons to reach their potential in the OR.