This project aimed to develop an AI-scalable rating scale for gastric bypass procedures to identify best in class procedures, an individual surgeon’s detailed status and to deliver deep datasets for research. Considering these requirements, the rating criteria were designed with binary items for best in class and poor performance. The rating scale including procedure steps, tasks and rating criteria was developed and tested by 3 surgeons.

Fifteen expert bariatric surgeons with >500 minimally invasive RYGB procedures and at least two years of teaching experience were recruited to validate the rating scale during a modified Delphi process with three rounds (two anonymous online surveys, one face-to-face meeting via videoconferencing). During each round, all items were rated to accept “as-is”, to suggest modifications, or to exclude. The option was also given or to propose additional content. Consensus was assumed at 80% agreement. Items without agreement were moved to the next round until agreement was reached during the final face-to-face discussion.

The proposed rating scale included five procedure steps with 14 tasks. Through the project all the proposed steps and tasks reached consensus for inclusion, and two additional tasks were included. Thus, the final expert consensus-driven rating scale consists of five procedure steps and 16 procedure tasks: gastric pouch creation (dissection of angle of his, open lesser sac, horizontal stapling, posterior dissection, vertical stapling), gastro-jejunal anastomosis (enterotomy, gastrotomy, stapling, enterotomy closure), jejuno-jejunal anastomosis (enterotomies, stapling, enterotomy closure), measurement of small bowel (measurement of biliary loop, measurement of alimentary loop), and closure of mesentery (closure of Petersen’s Space, closure of mesenteric defect). Across the tasks, 48 rating criteria were initially proposed. Through the rounds, two were modified and none were deleted. Three novel criteria items were included, for a final of 51 rating criteria (please refer to images for examples of rating criteria).

The product of this project, which will be presented in detail at conference, is an expert consensus derived rating scale for gastric bypass. Next, this rating scale will undergo a video review-based validation.