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Invited Commentary
May 6, 2020

Considering Surgeon Skill in Randomized Clinical Trials

Author Affiliations
  • 1Institute for Healthcare Policy and Evaluation, University of Michigan, Ann Arbor
  • 2Department of Surgery, University of Michigan, Ann Arbor
  • 3Surgical Innovation Editor, JAMA Surgery
JAMA Surg. Published online May 6, 2020. doi:10.1001/jamasurg.2020.1039

To most surgeons, it comes as no surprise that the technical conduct of an operation is critically important to outcomes. It may be even be more important than patient disease severity, comorbidities, or the specific technique being used. In a study in this issue of JAMA Surgery, Curtis et al1 present a multi-institutional, multinational study about the development, reliability, and criterion validity of a technical skill assessment tool for laparoscopic total mesorectal excisions. They use a customized skill-assessment tool to evaluate 385 hours of video from 176 patients with cT1-T3 rectal adenocarcinomas less than 15 cm from the anal verge. They find that surgical skill as measured by their custom tool (LapTMEpt) is associated with improved histopathologically complete resections and lower 30-day morbidity.

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