Measuring fatigue and stress in laparoscopic surgery: validity and reliability of the star-track test

Abstract

Background: The star-track test has been assessed as valid and reliable to measure manual dexterity in the context of open surgery. We aimed to determine the construct validity and test-retest reliability of the star-track test for manual dexterity in a laparoscopic setting. Material and methods: The star-track test was performed in a laparoscopic box trainer. To determine construct validity an open-label, randomized four-period crossover trial was conducted. Alongside a baseline (non-interventional) measurement, interventions involved: physical fatigue, mental stress and a combination of these. The test-retest trial involved two separate (non-interventional) measurements. The primary outcome measures were accuracy, speed and manual dexterity (the integrated measure of accuracy and speed). Results: Participants made significantly more errors when physically fatigued, whereas participants performed the test significantly slower when mentally stressed. Manual dexterity was significantly affected in the case of combined intervention. High test-retest reliability was found for errors (ICC = 0.90) and completion time (ICC = 0.64). Fair test-retest reliability for the integrated measure was found (ICC = 0.37). Conclusion: The star-track test is a valid and reliable tool to evaluate the effect of physical fatigue and/or mental stress on the characteristics of manual dexterity in a laparoscopic setting.