Operative Performance Rating System (OPRS)

LAPAROSCOPIC CHOLECYSTECTOMY

Evaluator: Resident:

Resident Level: Program:

Date of Time Procedure Procedure: Was Completed: Date Assessment Time Assessment Was Completed: Was Initiated:

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 Intermediate difficulty Abnormal anatomy, related prior surgeries or extensive pathology, related treatment prior surgeries or treatment (for example radiation), or obesity ☐ ☐ ☐ ☐ ☐

Degree of Prompting or Direction Substantial Direction Some Direction Minimal Direction 1 2 3 4 5

Unable to direct team, Actively assists and Performs all steps and use/choose instruments, or anticipates own and directs team with minimal anticipate next steps as attending’s needs, performs direction from attending to surgeon or as first assistant basic steps with occasional either resident or team, i.e., without constant attending attending direction to anticipates needs, sets up prompting resident and/or surgical exposure for self and team. Somewhat hesitant assistant, transitions fluently and slow to anticipate or between steps, gives clear recognize aberrant direction to first assistant, anatomy, unexpected maintains situation findings, and/or “slowing awareness, calmly recovers down” moments from error and recognizes when to seek help/advice

☐ ☐ ☐ ☐ ☐ Published with permission of Southern Illinois University Department of Surgery Laparoscopic Cholecystectomy – Page 2 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 Fair Good Very Good Excellent 1 2 3 4 5 NA Poor choice of Functional but Safe, efficient port position, awkward port and optimal unsafe technique positioning, generally positioning of in insertion or safe technique, some ports for removal difficulty inserting ports procedure and anatomy ☐ ☐ ☐ ☐ ☐ ☐

Substantial Some Minimal Direction Direction Direction 1 2 3 4 5 NA ☐ ☐ ☐ ☐ ☐ ☐

Exposure Poor Fair Good Very Good Excellent 1 2 3 4 5 NA Poor/inadequate Adequate Optimizes exposure pneumoperitoneum, establishment and of Calot’s triangle, camera angle and maintenance of efficiently directs retraction with pneumoperitoneum, gallbladder retraction frequent loss of camera angle and and camera to exposure retraction but with maintain exposure occasional loss of and exposure and pneumoperitoneum difficulty inserting ports ☐ ☐ ☐ ☐ ☐ ☐

Substantial Some Minimal Direction Direction Direction 1 2 3 4 5 NA ☐ ☐ ☐ ☐ ☐ ☐ Laparoscopic Cholecystectomy – Page 3

Cystic Duct Dissection Poor Fair Good Very Excellent 1 2 3 Good 4 5 NA Dissection of duct Adequate but Expedient inadequate to inefficient dissection, safe place clips and dissection, clip placement divide safely clips secure but and duct division spacing not ideal ☐ ☐ ☐ ☐ ☐ ☐

Substantial Some Minimal Direction Direction Direction 1 2 3 4 5 NA ☐ ☐ ☐ ☐ ☐ ☐

Cystic Artery Dissection Poor Fair Good Very Excellent 1 2 3 Good 4 5 NA Dissection of artery Adequate but Expedient inadequate to place inefficient dissection, safe clips and divide safely, dissection, clips clip placement and excessive secure but artery division. hemorrhage, used spacing not ideal. more than 8 clips ☐ ☐ ☐ ☐ ☐ ☐

Substantial Some Minimal Direction Direction Direction 1 2 3 4 5 NA ☐ ☐ ☐ ☐ ☐ ☐

Gallbladder Dissection Poor Fair Good Very Good Excellent 1 2 3 4 5 NA Inefficient; did not Removed Efficient; cleanly gallbladder intact maintained clean remove gallbladder; but strayed from plane between excessive bile plane, somewhat gallbladder and spillage; repeated inefficient, minimal liver bed injury to liver bile spilled; extra throughout, no parenchyma cautery needed for parenchymal injury liver bleeding or bile spillage ☐ ☐ ☐ ☐ ☐ ☐

Substantial Some Minimal Direction Direction Direction 1 2 3 4 5 NA ☐ ☐ ☐ ☐ ☐ ☐ Laparoscopic Cholecystectomy – Page 4 General Criteria Instrument Handling Poor Fair Good Very Good Excellent 1 2 3 4 5 NA Tentative or Competent use Fluid movements awkward of instruments, with instruments movements, often occasionally consistently using did not visualize appeared appropriate force, tips of instrument awkward or did keeping tips in or clips poorly not visualize view, and placing placed instrument tips clips securely ☐ ☐ ☐ ☐ ☐ ☐

Respect for Tissue Poor Fair Good Very Good Excellent 1 2 3 4 5 NA Frequent Careful tissue Consistently unnecessary handling, handled tissue tissue force or occasional carefully damage by inadvertent (appropriately), inappropriate damage minimal tissue instrument use damage ☐ ☐ ☐ ☐ ☐ ☐

Time and Motion Poor Fair Good Very Good Excellent 1 2 3 4 5 NA Many Efficient time and Clear economy unnecessary motion, some of motion, and moves unnecessary maximum moves efficiency ☐ ☐ ☐ ☐ ☐ ☐

Operation Flow Poor Fair Good Very Good Excellent 1 2 3 4 5 NA Frequent lack of Some forward Obviously forward planning, planned course progression; reasonable of operation and frequently stopped procedure anticipation of operating and progression next steps seemed unsure of next move ☐ ☐ ☐ ☐ ☐ ☐ Laparoscopic Cholecystectomy – Page 5

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)

Poor Fair Good Very Good Excellent

☐ ☐ ☐ ☐ ☐

Please indicate the weaknesses in this resident’s performance:

Please indicate the strengths in this resident’s performance: