• Keerthini Muthuswamy, Rebecca Fisher, Stella Mavroveli, Fotis Petrou, Sabrina Khawar, Ashik Amlani, George B Hanna, Dimitri J Hadjiminas, ThiruchelvamPaul T RPTRImperial College Healthcare NHS Trust, London, UK., and Daniel R Leff.
• Department of Surgery and Cancer, Imperial College London, London, UK.
• Ann. Surg. 2022 Mar 1; 275 (3): e568-e574.

ObjectiveA simulator to enable safe practice and assessment of ALND has been designed, and face, content and construct validity has been investigated.Summary And Background DataThe reduction in the number of ALNDs conducted has led to decreased resident exposure and confidence.MethodsA cross-sectional multicenter observational study was carried out between July 2017 and August 2018. Following model development, 30 surgeons of varying experience (n = "experts," n = 11 "senior residents," and n = 10 "junior residents") were asked to perform a simulated ALND. Face and content validity questionnaires were administered immediately after ALND. All ALND procedures were retrospectively assessed by 2 attending breast surgeons, blinded to operator identity, using a video-based assessment tool, and an end product assessment tool.ResultsStatistically significant differences between groups were observed across all operative subphases on the axillary clearance assessment tool (P < 0.001). Significant differences between groups were observed for overall procedure quality (P < 0.05) and total number of lymph nodes harvested (P < 0.001). However, operator grade could not be distinguished across other end product variables such as axillary vein damage (P = 0.864) and long thoracic nerve injury (P = 0.094). Overall, participants indicated that the simulator has good anatomical (median score >7) and procedural realism (median score >7).ConclusionsVideo-based analysis demonstrates construct validity for ALND assessment. Given reduced ALND exposure, this simulation is a useful adjunct for both technical skills training and formative Deanery or Faculty administered assessments.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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