Assessment of Technical Skills in Axillary Lymph Node Dissection. Issue 3 (March 2022)

• Record Type: Journal Article
• Authors: Muthuswamy, Keerthini; Fisher, Rebecca; Mavroveli, Stella; Petrou, Fotis; Khawar, Sabrina; Amlani, Ashik; Hanna, George B.; Hadjiminas, Dimitri J.; Thiruchelvam, Paul T. R.; Leff, Daniel R.
• Is Part Of: Annals of surgery. Volume 275:Issue 3(2022)
• Publication Date: 2022-03
• Subjects: ALND -- axillary clearance -- breast surgery -- education -- simulation; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000003946
• Languages: English
• ISSNs: 0003-4932

Abstract

Abstract : Objective: A simulator to enable safe practice and assessment of ALND has been designed, and face, content and construct validity has been investigated. Summary and Background Data: The reduction in the number of ALNDs conducted has led to decreased resident exposure and confidence. Methods: A cross-sectional multicenter observational study was carried out between July 2017 and August 2018. Following model development, 30 surgeons of varying experience (n = "experts, " n = 11 "senior residents, " and n = 10 "junior residents") were asked to perform a simulated ALND. Face and content validity questionnaires were administered immediately after ALND. All ALND procedures were retrospectively assessed by 2 attending breast surgeons, blinded to operator identity, using a video-based assessment tool, and an end product assessment tool. Results: Statistically significant differences between groups were observed across all operative subphases on the axillary clearance assessment tool ( P < 0.001). Significant differences between groups were observed for overall procedure quality ( P < 0.05) and total number of lymph nodes harvested ( P < 0.001). However, operator grade could not be distinguished across other end product variables such as axillary vein damage ( P = 0.864) and long thoracic nerve injury ( P = 0.094). Overall, participants indicated that the simulator has good anatomical (median score >7) and procedural realism (median score >7). Conclusions: Video-based analysis demonstrates construct validity for ALND assessment. Given reduced ALND exposure, this simulation is a useful adjunct for both technical skills training and formative Deanery or Faculty administered assessments. Abstract : Supplemental Digital Content is available in the text