LAP VENTRAL HERNIA RATING FORM
Evaluator:
Subject:
Status:
Program:
Please rate this resident's performance during this operative procedure. The
caption above each item provides descriptive anchors for 3 of the 5 points on the
rating scale. "N/A" (Not applicable) should only be selected when the resident did
not perform that part of the procedure.
Patient Location
MMC Inpatient
O
St. John’s Inpatient
MMC Outpatient
(23 hour )
O
O
St John’s Outpatient
(23 hour )
O
Hospital Medical Record Number
Date of Procedure
MM/DD/YY
OPRS Case Difficulty
Indicate the difficulty of the case:
1
Straightforward anatomy, no
related prior surgeries or
treatment
O
2
Intermediate difficulty
O
3
Abnormal anatomy, extensive
pathology, related prior
surgeries or treatment (for
example radiation), or obesity
O
1
Degree of Prompting or Direction
1
2
Substantial direction
by attending. Resident
performs all steps but
the attending provides
constant direction to
the resident and
surgical team.
3
Some direction by
attending. Resident
performs all steps but
the attending provides
occasional direction to
the resident and /or to
the surgical team.
O
Minimal direction by
attending. Resident
performs all steps and
directs the surgical
team independently
with minimum or no
direction from the
attending, to either the
resident or to the
surgical team.
O
O
Procedure Specific Criteria
Incision / Port Placement
5
Excellent
4
Very Good
Safe, efficient
and optimal
positioning of
ports for
procedure, &
anatomy
O
O
3
Good
2
Fair
Functional
but awkward
port
positioning,
generally
safe
technique,
some
difficulty
inserting
ports.
O
1
Poor
NA
Poor
choice of
port
position,
unsafe
technique
insertion
/removal.
O
O
O
Exposure - Pneumoperitoneum
5
Excellent
Efficient
establishment &
maintenance of
appropriate
pneumoperitoneum,
camera angle and
retraction
4
Very
Good
3
Good
Adequate
establishment and
maintenance of
pneumoperitoneum,
camera angle and
retraction but with
occasional loss of
2
Fair
1
Poor
NA
Inadequate
pneumoperitoneum,
camera angle and
retraction with
frequent loss of
exposure
2
O
O
exposure.
O
O
O
O
Exposure – Identification
5
Excellent
4
Very Good
2
Fair
1
Poor
NA
O
O
Poor
dissection
technique with
inadequate
exposure of
fascial edge
and sac.
Complete
reliance on
faculty for
identification
of sac &
reduction of
sac and
contents.
O
O
4
Very Good
3
Good
2
Fair
1
Poor
NA
O
Satisfactory
(required
some
direction)
sizing of
mesh, and
positioning of
sutures
O
O
O
O
3
Good
2
Fair
1
Poor
NA
Precise and
efficient
dissection of
adhesions to
expose entire
fascial edge,
sac and
contents.
Efficient
reduction of
sac
O
3
Good
Satisfactory
dissection &
mobilization
with
occasional
inefficient
dissection.
Incomplete
exposure of
fascial edge.
Satisfactory
reduction of
sac.
O
Preparation of mesh
5
Excellent
Excellent
(independent)
sizing of
mesh, &
positioning of
sutures..
O
Inadequate or
inappropriate
sizing of mesh
with complete
reliance on
faculty
instruction.
Placement of mesh
5
Excellent
Excellent
positioning &
placement of
sutures
without
tension or
redundancy.
4
Very Good
Satisfactory
(required
some
direction),
placement
without
tension or
Inadequate
orientation of
mesh, &
suturing with
complete
reliance on
faculty
3
O
O
redundancy.
O
O
instruction.
O
O
General Criteria
Instrument Handling
5
Excellent
4
Very Good
Fluid
movements
with
instruments
consistently
using
appropriate
force, keeping
tips in view,
and placing
clips placed
securely.
3
Good
2
Fair
Competent
use of
instruments,
occasionally
appeared
awkward, or
did not
visualize
instrument
tips
O
O
1
Poor
NA
Tentative or
awkward
movements
often did not
visualize tips
of instrument,
or clips poorly
placed.
O
O
O
O
3
Good
2
Fair
1
Poor
NA
Respect for Tissue
5
Excellent
4
Very Good
Consistently
handled tissue
carefully
(appropriately),
minimal tissue
damage
Frequent
unnecessary
tissue force or
damage by
inappropriate
instrument
use.
Careful tissue
handling,
occasional
inadvertent
damage
O
O
O
O
O
O
4
Very Good
3
Good
2
Fair
1
Poor
NA
Time and Motion
5
Excellent
Clear
economy of
motion, and
maximum
efficiency
O
Efficient time
& motion,
some
unnecessary
moves
O
O
Many
unnecessary
moves
O
O
O
4
Operation Flow
5
Excellent
4
Very
Good
Obviously
planned
course of
operation and
anticipation of
next steps.
3
Good
2
Fair
1
Poor
□
Some
forward
planning,
reasonable
procedure
progression
NA
Frequent
lack of
forward
progression;
frequently
stopped
operating
and seemed
unsure of
next move
.
O
O
O
O
O
O
Overall Performance
5
Excellent
4
Very
Good
3
Good
2
Fair
1
Poor
NA
O
O
O
O
O
O
Please indicate the weaknesses in this resident’s performance:
Please indicate the strengths in this resident’s performance:
References
5
1. Bingener J, Buck L, Richards M et al. Long term outcomes in laparoscopic
vs. open ventral hernia repair. Arch Surg 2007; 142: 562 - 567.
2. Birch D. Characterizing laparoscopic incisional hernia repair. Can J Surg.
2007;50(3):195 - 200
3. Novitsky Y, Cobb W, Kercher KW et al. Laparoscopic ventral hernia repair
in obese patients. Arch Surg 2006; 141:57 - 61.
4. Perrone J, Soper NJ, Eagon C et al. Perioperative outcomes and
complications of laparoscopic ventral hernia repair. Surgery 2005; 138:708
- 16.
5. Mudge, M, Hughes, LE. Incisional hernia: a 10 year prospective study of
incidence and attitudes. Br J Surg 1985; 72:70.
6. Hodgson, NC, Malthaner, RA, Ostbye, T. The search for an ideal method
of abdominal fascial closure: a meta-analysis. Ann Surg 2000; 231:436.
7. Flum, DR, Horvath, K, Koepsell, T. Have outcomes of incisional hernia
repair improved with time? A population-based analysis. Ann Surg 2003;
237:129.
8. DeMaria, EJ, Moss, JM, Sugerman, HJ. Laparoscopic intraperitoneal
polytetrafluoroethylene (PTFE) prosthetic patch repair of ventral hernia.
Prospective comparison to open prefascial polypropylene mesh repair.
Surg Endosc 2000; 14:326.
9. Cobb, WS, Kercher, KW, Heniford, BT. Laparoscopic repair of incisional
hernias. Surg Clin North Am 2005; 85:91.
10. Berger, D, Bientzle, M, Muller, A. Postoperative complications after
laparoscopic incisional hernia repair. Incidence and treatment. Surg
Endosc 2002; 16:1720.
11. Heniford, BT, Park, A, Ramshaw, BJ, Voeller, G. Laparoscopic repair of
ventral hernias: nine years' experience with 850 consecutive hernias. Ann
Surg 2003; 238:391.
12. Ujiki, MB, Weinberger, J, Varghese, TK, et al. One hundred consecutive
laparoscopic ventral hernia repairs. Am J Surg 2004; 188:593.
13. Cassar, K, Munro, A. Surgical treatment of incisional hernia. Br J Surg
2002; 89:534.
14. Carbajo, MA, Martin, del Olmo JC, Blanco, JI, et al. Laparoscopic
treatment vs. open surgery in the solution of major incisional and
abdominal wall hernias with mesh. Surg Endosc 1999; 13:250.
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