Correcting the Fundamentals of Laparoscopic Surgery “Illusion of Validity” in Laparoscopic Vaginal Cuff Suturing

There was a stronger association with cadaver cuff suturing time for simulated vaginal cuff suturing time (r: 0.73, P<0.001) compared to FLS intracorporeal contralateral suturing time (r: 0.54, P<0.001). Additional measures associated with cadaveric performance included subspecialty training (Median: 82 vs. 185 seconds, P=0.002), number of total laparoscopic hysterectomies (r: -0.53, P<0.001), number of laparoscopic cuff closures (r: -0.61, P<0.001), number of simulated laparoscopic suturing experiences (r: -0.51, P<0.001), and eyelet contralateral time (r: 0.52, P<0.001). Strong agreement between the in-person and blinded GOALS (ICC=0.80) supports response process evidence. Correlations of cadaver cuff time with in-person (Spearman's r: -0.84, P<0.001), and blinded GOALS (r: -0.76, P<0.001) supports relations to other variables evidence CONCLUSION: : The weaker correlation between FLS suturing and cadaver cuff suturing compared to a simulated vaginal cuff model may lead to an "illusion of validity" for assessment in gynecology. Since gynecology specific validity evidence has not been well established for FLS, we recommend prioritizing the use of a simulated-vaginal cuff suturing assessment in addition to FLS.