Video Assessment of Laparoscopic Cholecystectomy: A Validation Study to Develop a Criterion-Based Scoring Tool for Performance

OBJECTIVE: Surgical education requires effective skill transfer and objective assessment. Existing competency evaluations often rely on subjective observations. This study aims to validate a quantitative video-based assessment rubric for laparoscopic cholecystectomy and formulate a criterion-based scoring instrument. DESIGN: A prospective cohort study at Northern Health, Melbourne. SETTING: De-identified performance of laparoscopic cholecystectomy videos collected from consultant surgeons and surgical trainees. The assessment framework included quantitative performance benchmarks and case difficulty variables. PARTICIPANTS: Four specialist general surgeons accredited as fellows of the Royal Australasian College of Surgeons (FRACS), comprising of 2 consultants and 2 fellows, alongside 4 trainee registrars enrolled in a formal surgical training program. Three hepatopancreatobiliary surgeons rated the videos. RESULTS: Analysis of 80 videos showed moderate (0.5-0.75) to good (0.5-0.9) interrater agreement. Trainees took longer to achieve critical view of safety (14.2 minutes versus 9.8 minutes for consultants; p = 0.014) and rotated the gallbladder more frequently (7.5 versus 4.0 times; p = 0.024). Subjective performance ratings correlated with poorer achievement of critical view of safety components, and lower counts of the number of Hartmann's pouch grasping, gallbladder rotation, incorrect clipping, lack of progress and perforation. A scoring system was derived, with a cut-off score of 9 for easier cases, and score of 7 for harder cases, and achieved a ROC AUC of 0.81 and 0.78 respectively, in performance assessment. CONCLUSIONS: This study validates a video-based assessment rubric capable of correlating with criterion-based assessment outcomes in laparoscopic cholecystectomy. The developed scoring instrument offers a structured, objective approach to surgical assessment, facilitating technical progress monitoring and identifying areas for improvement, thus supporting a more objective evaluative framework in surgical education.