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Urology. 2012 Dec;80(6):1277-82. doi: 10.1016/j.urology.2012.06.065.

Audio and visual analysis of urologic laparoscopic and robotic skills: objective criteria for surgical skill evaluation.

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The Arthur Smith Institute for Urology, Hofstra North Shore-Long Island Jewish School of Medicine, New Hyde Park, New York11040, USA.



To assess intraoperative cognitive and motor skills using audio- and video-based analysis.


The study enrolled 11 surgeons who were categorized into novice (n = 4), intermediate (n = 4), and expert (n = 3) groups. Categorization of skill level was based on years of experience and as determined by the lead expert surgeon. A total of 32 cases were available for analysis, including 5 robotic and 27 laparoscopic renal cases. For each procedure, video and audio components were recorded and sent for grading to 4 blinded judges. The previously validated global rating scale (GRS) and operation-specific rating scale (ORS), as well as a novel cognitive rating scale (CRS), were used to assess performances. Statistical comparisons were performed by analysis of variance.


Comparison of the 3 skill levels using analysis of variance showed that each scale was able to differentiate among the levels (P <.05). The mean scores for the before and after audio GRS, ORS, and CRS showed significant difference between the novice, intermediate, and expert groups, demonstrating construct validity.


The use of intraoperative audio is an innovative way to assess the cognitive ability of the surgeon. The CRS demonstrated construct validity. The addition of the CRS to the already validated GRS and ORS may serve as a reliable system to objectively evaluate laparoscopic and robotic surgical skill.

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