Development and validation of an objective skills scoring system for robotic inguinal hernia repairs

Abstract Competency-based surgical education requires objective, scalable assessment of technical skill, yet existing rating scales are subjective. Objective performance indicators (OPIs) derived from console kinematics, offer a solution; however, they lack a validated scoring framework. We developed and externally validated an OPI-based scoring system from robotic transabdominal preperitoneal inguinal hernia repairs performed by 6 attendings and 41 trainees at an academic center (2023–2026). Nineteen OPIs across four tasks were grouped into eight domains, reduced by principal component analysis, and integrated into task-specific 0–100 composite scores via ridge logistic regression. Among 2588 tasks from 392 cases, cross-validated AUCs for attending-trainee discrimination were 0.62–0.74, and composite scores increased from postgraduate year 2 to attending (Spearman ρ, 0.94–1.00; P ≤ 0.005). In an independent external cohort (84 observations, 21 cases), the overall AUC was 0.84 (95% CI, 0.69–0.93). This framework enables objective technical skills assessment in robotic hernia repair.