Development and Validation of an Objective Scoring Tool for Robot-Assisted Radical Prostatectomy: Prostatectomy Assessment and Competency Evaluation (PACE).

and Background: Comprehensive training and skill acquisition by urologic surgeons are vital to optimize surgical outcomes and patient safety. We sought to develop and validate an objective and procedure specific tool to assess the quality of robot-assisted radical prostatectomy (RARP)-Prostatectomy Assessment and Competence Evaluation (PACE) METHODS: Development and content validation of PACE was performed by deconstruction of RARP into seven key domains utilizing the Delphi methodology.

The reliability and construct validation were then assessed utilizing de-identified videos performed by practicing surgeons and fellows. Consensus for each domain was defined as achieving a content validity index (CVI) ≥0.75. Reliability was assessed using intra-class correlation (ICC) and construct validation using a mixed linear model accounting for multiple ratings on the same video. Consensus was reached after 3 rounds on wording, relevance of skills assessed, and concordance between the score assigned and the skill assessed. ICC ≥ 0.4 was achieved for all domains. The expert group outperformed trainees in all domains but reached statistical significance in bladder drop (4.5 versus 3.4, p=0.002), preparation of the prostate (4.4 versus 3.2, p<0.0001), seminal vesicles and posterior plane dissection (8.3 versus 6.8, p=0.03) and neurovascular bundle preservation (4.1 versus 2.4, p<0.0001). Limitations include the lack of assessment of other key skills as communication and decision making.

PACE is a structured, procedure-specific and reliable tool that objectively measures surgical performance during RARP. It can differentiate different levels of expertise, and provide structured feedback to customize training and surgical quality improvement.

The Journal of urology. 2016 Jan 29 [Epub ahead of print]

Ahmed A Hussein, Khurshid R Ghani, James Peabody, Richard Sarle, Ronney Abaza, Daniel Eun, Jim Hu, Michael Fumo, Brian Lane, Jeffrey Montgomery, Nobuyuki Hinata, Deborah Rooney, Bryan Comstock, Hei Kit Chan, Sridhar S Mane, James L Mohler, Gregory Wilding, David Miller, Khurshid A Guru, Michigan Urological Surgery Improvement Collaborative and Applied Technology Laboratory for Advanced Surgery Program

Department of Urology, Roswell Park Cancer Institute, Buffalo, NY; Department of Urology, Cairo University, Egypt., Department of Urology, University of Michigan, Ann Arbor, MI., Henry Ford Health System, Detroit, MI., Michigan Institute of Urology; Dearborn, MI., OhioHealth, Dublin, OH., Lewis Katz School of Medicine at Temple University, PA., Weil Cornell, New York, NY., Henry Ford Medical Group, Detroit, MI., Spectrum Health Medical, Grand Rapids, MI., University of Kobe, Japan., Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI., University of Washington, Seattle., Department of Urology, Roswell Park Cancer Institute, Buffalo, NY., Department of Urology, Roswell Park Cancer Institute, Buffalo, NY. Electronic address: .

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