Operative Performance Rating System (OPRS) LAPAROSCOPIC VENTRAL HERNIA Evaluator: Resident: Resident Level: Program: Please rate this resident's performance during this operative procedure. For most criteria, the caption above each checkbox provides descriptive anchors for 3 of the 5 points on the rating scale. "NA" (not applicable) should only be selected when the resident did not perform that part of the procedure. Case Difficulty 1 2 3 4 5 Straightforward anatomy, no related prior surgeries or treatment Intermediate difficulty Abnormal anatomy, extensive pathology, related prior surgeries or treatment (for example radiation), or obesity Degree of Prompting or Direction Substantial Direction 1 2 Some Direction 3 4 Minimal Direction 5 Unable to direct team, use/choose instruments, or anticipate next steps as surgeon or as first assistant without constant attending prompting Actively assists and anticipates own and attending’s needs, performs basic steps with occasional attending direction to resident and/or surgical team. Somewhat hesitant and slow to anticipate or recognize aberrant anatomy, unexpected findings, and/or “slowing down” moments Performs all steps and directs team with minimal direction from attending to either resident or team, i.e., anticipates needs, sets up exposure for self and assistant, transitions fluently between steps, gives clear direction to first assistant, maintains situation awareness, calmly recovers from error and recognizes when to seek help/advice
Procedure-Specific Criteria Please assess performance and indicate the degree of prompting for each item. The assessment score for each item may differ from the prompting score for that item. Incision / Port Placement Poor 1 Fair 2 Good 3 Very Good 4 Excellent 5 NA Poor choice of port position; unsafe technique in insertion or removal Functional but somewhat awkward port positioning; generally safe technique; some difficulty inserting ports Safe, efficient and optimal positioning of ports for procedure and anatomy Substantial Direction 1 2 Some Direction 3 4 Minimal Direction 5 NA Exposure - Pneumoperitoneum Poor 1 Fair 2 Good 3 Very Good 4 Excellent 5 NA Inadequate pneumoperitoneum, camera angle and retraction with frequent loss of exposure Adequate establishment and maintenance of appropriate pneumoperitoneum, camera angle and retraction but with occasional loss of exposure Efficient establishment and maintenance of appropriate pneumoperitoneum, camera angle and retraction Substantial Direction 1 2 Some Direction 3 4 Minimal Direction 5 NA Exposure - Identification Poor 1 Fair 2 Good 3 Very Good 4 Excellent 5 NA
Poor dissection technique with inadequate exposure of fascial edge and sac. Complete reliance on faculty for identification of sac and reduction of sac and contents Satisfactory dissection and mobilization with occasional inefficient dissection. Incomplete exposure of fascial edge. Satisfactory reduction of sac Precise and efficient dissection of adhesions to expose entire fascial edge, sac and contents. Efficient reduction of sac Substantial Direction 1 2 Some Direction 3 4 Minimal Direction 5 NA Preparation of Mesh Poor 1 Fair 2 Good 3 Very Good 4 Excellent 5 NA Inadequate or inappropriate sizing of mesh with complete reliance on faculty instruction Satisfactory (required some direction) sizing of mesh, and positioning of sutures Excellent (independent) sizing of mesh, and positioning of sutures Substantial Direction 1 2 Some Direction 3 4 Minimal Direction 5 NA Placement of Mesh Poor 1 Fair 2 Good 3 Very Good 4 Excellent 5 NA Inadequate orientation of mesh, and suturing with complete reliance on faculty instruction Satisfactory (required some direction), placement without tension or redundancy Excellent positioning and placement of sutures without tension or redundancy Substantial Direction 2 Some Direction 4 Minimal Direction NA
1 3 5 General Criteria Instrument Handling Poor 1 Fair 2 Good 3 Very Good 4 Excellent 5 NA Tentative or awkward movements, often did not visualize tips of instrument or clips poorly placed Competent use of instruments, occasionally appeared awkward or did not visualize instrument tips Fluid movements with instruments consistently using appropriate force, keeping tips in view, and placing clips securely Respect for Tissue Poor 1 Fair 2 Good 3 Very Good 4 Excellent 5 NA Frequent unnecessary tissue force or damage by inappropriate instrument use Careful tissue handling, occasional inadvertent damage Consistently handled tissue carefully (appropriately), minimal tissue damage Time and Motion Poor 1 Fair 2 Good 3 Very Good 4 Excellent 5 NA Many unnecessary moves Efficient time and motion, some unnecessary moves Clear economy of motion, and maximum efficiency Operation Flow Poor 1 Fair 2 Good 3 Very Good 4 Excellent 5 NA Frequent lack of forward progression; frequently stopped operating and seemed unsure of next move Some forward planning, reasonable procedure progression Obviously planned course of operation and anticipation of next steps Overall Performance (not included in calculation of mean score) Rating of very good or higher indicates technically proficient performance (i.e., resident is ready to perform operation independently, assuming resident consistently performs at this level)