首个基于专家共识的微创结直肠手术流程评估工具，可标准化手术分析。
Expert Consensus-based Video-Based Assessment Tool for Workflow Analysis in Minimally Invasive Colorectal Surgery: Development and Validation of ColoWorkflow
- 通过专家德尔菲法达成共识，构建通用流程阶段与具体步骤框架。
- 在54段多中心手术视频上验证，阶段与步骤的评分者间一致性中等（K=0.71和0.66）。
- 适合用于手术培训标准化、智能识别系统开发及跨机构质量评估。
微创结直肠手术具有操作变异性大、学习曲线陡峭及并发症多等特点，影响手术质量和结果。视频为基础的评估（VBA）为生成数据驱动洞见提供了可能，有助于减少变异性、优化培训并提升手术表现。然而，现有工作流程分析工具难以标准化与实施。本研究旨在开发并验证一种用于微创结直肠手术（CRS）工作流程分析的VBA工具。通过德尔菲法达成对通用工作流程描述符的共识，形成框架并指导新工具ColoWorkflow的开发。独立评审员将ColoWorkflow应用于包含腹腔镜与机器人手术的多中心视频数据集（共54例，涵盖左半结肠切除、右半结肠切除、乙状结肠及直肠乙状结肠切除、全结直肠切除）。评估了工具的适用性与评分者间信度。共识达成10个无特定术式阶段和34个特定术式步骤。工具应用广泛，仅1个标签未使用。评分者间信度中等，阶段平均Cohen's K为0.71，步骤为0.66，主要差异出现在阶段转换和步骤边界界定处。ColoWorkflow是首个基于专家共识且经验证的全面微创结直肠手术工作流程分析工具，建立了可重复的视频评估框架，支持跨机构基准对比，并助力人工智能驱动的工作流程识别发展。其应用有望实现培训标准化、加速能力掌握，并推动数据驱动的手术质量改进。
原文摘要 · Abstract (English)
Minimally invasive colorectal surgery is characterized by procedural variability, a difficult learning curve, and complications that impact quality and outcomes. Video-based assessment (VBA) offers an opportunity to generate data-driven insights to reduce variability, optimize training, and improve surgical performance. However, existing tools for workflow analysis remain difficult to standardize and implement. This study aims to develop and validate a VBA tool for workflow analysis across minimally invasive colorectal procedures. A Delphi process was conducted to achieve consensus on generalizable workflow descriptors. The resulting framework informed the development of a new VBA tool, ColoWorkflow. Independent raters then applied ColoWorkflow to a multicentre video dataset of laparoscopic and robotic colorectal surgery (CRS). Applicability and inter-rater reliability were evaluated. Consensus was achieved for 10 procedure-agnostic phases and 34 procedure-specific steps describing CRS workflows. ColoWorkflow was developed and applied to 54 colorectal operative videos (left and right hemicolectomies, sigmoid and rectosigmoid resections, and total proctocolectomies) from five centres. The tool demonstrated broad applicability, with all but one label utilized. Inter-rater reliability was moderate, with mean Cohen's K of 0.71 for phases and 0.66 for steps. Most discrepancies arose at phase transitions and step boundary definitions. ColoWorkflow is the first consensus-based, validated VBA tool for comprehensive workflow analysis in minimally invasive CRS. It establishes a reproducible framework for video-based performance assessment, enabling benchmarking across institutions and supporting the development of artificial intelligence-driven workflow recognition. Its adoption may standardize training, accelerate competency acquisition, and advance data-informed surgical quality improvement.
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