Diagnostic Accuracy and Reproducibility of Predicting Cul-de-Sac Obliteration by General Gynaecologists and Minimally Invasive Gynaecologic Surgeons

Mathew Leonardi, Shannon Reid, Chuan Lu, Bassem Gerges, Tim Chang, Luk Rombauts, Martin Healey, Danny Chou, Sarah Choi, Dheya Al-Mashat, Robert Magotti, Ralph Nader

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6 Citations (SciVal)

Abstract

Objective
Knowledge of rectouterine cul-de-sac state and consistent classification among surgeons are important in the surgical management of women with endometriosis. The objective of this study was to determine the diagnostic accuracy and interobserver and intraobserver agreement among general gynaecologists (GGs) and minimally invasive gynaecologic surgeons (MIGSs) in the prediction of cul-de-sac obliteration at off-line analysis of laparoscopic videos.

Methods
Five GGs and five MIGSs viewed 33 prerecorded laparoscopic video sets off-line to determine cul-de-sac obliteration state (non-obliterated, partially obliterated, or completely obliterated) on two occasions (at least 7 days apart). Diagnostic accuracy and interobserver and intraobserver agreement were evaluated.

Results
The interobserver agreements for all 10 observers for the description of cul-de-sac state ranged from fair to substantial agreement, with moderate overall agreement. MIGSs had slightly higher within-group interobserver agreement compared with GGs. MIGSs achieved overall almost perfect intraobserver agreement compared with substantial agreement for GGs. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value for MIGSs classifying the cul-de-sac state were 83.9%, 88.5%, 88.5%, 89.2%, 92.0%, and 84.7%, respectively, whereas for GGs, they were 79.1%, 79.4%, 88.1%, 89.9%, and 76.1%, respectively.

Conclusion
Diagnostic accuracy and interobserver and intraobserver agreement for cul-de-sac obliteration state classification is acceptable in both groups. MIGSs had greater diagnostic accuracy and exhibited high interobserver and intraobserver agreement, a finding suggesting that their advanced training makes them more reliable in cul-de-sac obliteration assessment. Partial cul-de-sac obliteration was the most commonly incorrectly diagnosed state, thus implying that partial obliteration is not well understood.
Original languageEnglish
Pages (from-to)443-449.e2
JournalJournal of Obstetrics and Gynaecology Canada
Volume41
Issue number4
Early online date22 Oct 2018
DOIs
Publication statusPublished - 01 Apr 2019

Keywords

  • rectouterine pouch
  • diagnostic accuracy
  • interobserver agreement
  • intraobserver agreement
  • reproducibility study
  • Rectouterine pouch
  • Endometriosis/pathology
  • Reproducibility of Results
  • Gynecology
  • Humans
  • Cytoreduction Surgical Procedures
  • Douglas' Pouch/pathology
  • Surgeons
  • Video Recording
  • Female
  • Postoperative Complications/diagnosis

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