Assessment of basic human performance resources predicts operative performance of laparoscopic surgery

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Abstract
Interest in laparoscopic surgery has prompted development of educational programs designed to teach and assess laparoscopic skills. Although these programs are beneficial, because of the inherent demands imposed by laparoscopy some aspects of operative performance might not improve with practice. This suggests that innate ability could predict level of operative skill. Assessment of operative and technical potential to date has relied largely on subjective rather than objective criteria. In this study, the relationships between objective measures of human basic performance resources (BPRs) and laparoscopic performance were evaluated using Nonlinear Causal Resource Analysis (NCRA), a novel predictive and explanatory modeling approach based on General Systems Performance Theory. Twenty urology residents were voluntary enrolled. Thirteen validated BPRs were measured and analyzed relative to operative laparoscopic performance (assessed by two experts) of two porcine laparoscopic nephrectomies (LN). The laparoscopic procedure, representing a High Level Task (HLT), was evaluated using a modified Global Rating of Operative Performance Scale. NCRA models were devised to predict performance of the HLT laparoscopic nephrectomies based on BPRs and to determine the limiting performance resource. NCRA models predicted excellent agreement with actual operative performance, suggesting that measures of innate ability (or BPRs) predicted performance of laparoscopic nephrectomy. In 65%, the prediction by NCRA was near identical to the expert rating on the HLT. In 25% of cases, NCRA overpredicted performance; in 10%, NCRA underpredicted performance of the HLT compared to the subjective ratings. Neuromotor channel capacity was the most common performance-limiting resource. Preliminary findings suggest objective prediction of laparoscopic performance with limiting resource diagnostics for an individual surgeon is possible and practical using appropriate new measurement and modeling methods. Selection of surgical candidates, training, and educational curriculum could be positively affected.