Send to

Choose Destination
Surg Endosc. 2019 Aug 26. doi: 10.1007/s00464-019-07077-2. [Epub ahead of print]

Competency assessment tool for laparoscopic suturing: development and reliability evaluation.

Author information

Department of Surgery, Radboud University Medical Center, Geert Grooteplein zuid 10, 6525 GA, Nijmegen, Gelderland, The Netherlands.
Radboud University Medical Center, PO Box 9101 (960), 6500 HB, Nijmegen, The Netherlands.
Department of Surgery, Radboud University Medical Center, Geert Grooteplein zuid 10, 6525 GA, Nijmegen, Gelderland, The Netherlands.
Research and Education, Catharina Hospital, Michelangelolaan 2, 5653 EJ, Eindhoven, The Netherlands.
Delft University of Technology, Industrial Design Engineering, Medising, Delft, The Netherlands.
Department of Surgery, GSL Medical College, Rajahmundry, India.
Department of Surgery, Yeovil District Hospital NHS Foundation Trust, Yeovil, UK.
Division of Pediatric Surgery, Department of Surgery, Radboudumc - Amalia Children's Hospital, Nijmegen, The Netherlands.



Laparoscopic suturing can be technically challenging and requires extensive training to achieve competency. To date no specific and objective assessment method for laparoscopic suturing and knot tying is available that can guide training and monitor performance in these complex surgical skills. In this study we aimed to develop a laparoscopic suturing competency assessment tool (LS-CAT) and assess its inter-observer reliability.


We developed a bespoke CAT tool for laparoscopic suturing through a structured, mixed methodology approach, overseen by a steering committee with experience in developing surgical assessment tools. A wide Delphi consultation with over twelve experts in laparoscopic surgery guided the development stages of the tool. Following, subjects with different levels of laparoscopic expertise were included to evaluate this tool, using a simulated laparoscopic suturing task which involved placing of two surgical knots. A research assistant video recorded and anonymised each performance. Two blinded expert surgeons assessed the anonymised videos using the developed LS-CAT. The LS-CAT scores of the two experts were compared to assess the inter-observer reliability. Lastly, we compared the subjects' LS-CAT performance scores at the beginning and end of their learning curve.


This study evaluated a novel LS-CAT performance tool, comprising of four tasks. Thirty-six complete videos were analysed and evaluated with the LS-CAT, of which the scores demonstrated excellent inter-observer reliability. Cohen's Kappa analysis revealed good to excellent levels of agreement for almost all tasks of both instrument handling and tissue handling (0.87; 0.77; 0.75; 0.86; 0.85, all with pā€‰<ā€‰0.001). Subjects performed significantly better at the end of their learning curve compared to their first attempt for all LS-CAT items (all with pā€‰<ā€‰0.001).


We developed the LS-CAT, which is a laparoscopic suturing grading matrix, with excellent inter-rater reliability and to discriminate between experience levels. This LS-CAT has a potential for wider use to objectively assess laparoscopic suturing skills.


Evaluation; Laparoscopic suturing; Objective assessment; Simulation; Training


Supplemental Content

Full text links

Icon for Springer
Loading ...
Support Center