Imperial College London

Mr Daniel Richard Leff

Faculty of MedicineDepartment of Surgery & Cancer

Reader in Breast Surgery



+44 (0)20 3312 1947d.leff




Queen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus






BibTex format

author = {Muthuswamy, K and Fisher, R and Mavroveli, S and Petrou, F and Khawar, S and Amlani, A and Hanna, GB and Hadjiminas, D and Thiruchelvam, P and Leff, D},
doi = {10.1097/SLA.0000000000003946},
journal = {Annals of Surgery},
title = {Assessment of technical skills in axillary lymph node dissection},
url = {},
year = {2020}

RIS format (EndNote, RefMan)

AB - Objective A simulator to enable safe practice and assessment of ALND has been designed, and face, content and construct validity has been investigated.Summary and Background Data The reduction in the number of ALNDs conducted has led to decreased resident exposure and confidence. MethodsA cross-sectional multi-center observational study was carried out between July 2017 to August 2018. Following model development, 30 surgeons ofvarying experience (n=9 ‘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 two 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 sub-phases on theaxillary 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 R1 ALND Structured abstract(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 orFaculty administered assessments.
AU - Muthuswamy,K
AU - Fisher,R
AU - Mavroveli,S
AU - Petrou,F
AU - Khawar,S
AU - Amlani,A
AU - Hanna,GB
AU - Hadjiminas,D
AU - Thiruchelvam,P
AU - Leff,D
DO - 10.1097/SLA.0000000000003946
PY - 2020///
SN - 0003-4932
TI - Assessment of technical skills in axillary lymph node dissection
T2 - Annals of Surgery
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ER -