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Development and validation of surgical training tool: cystectomy assessment and surgical evaluation (CASE) for robot-assisted radical cystectomy for men

  • Ahmed A. Hussein
  • Kevin J. Sexton
  • Paul R. May
  • Maxwell V. Meng
  • Abolfazl Hosseini
  • Daniel D. Eun
  • Siamak Daneshmand
  • Bernard H. Bochner
  • James O. Peabody
  • Ronney Abaza
  • Eila C. Skinner
  • Richard E. Hautmann
  • Khurshid A. Guru
Article
  • 81 Downloads

Abstract

Background

We aimed to develop a structured scoring tool: cystectomy assessment and surgical evaluation (CASE) that objectively measures and quantifies performance during robot-assisted radical cystectomy (RARC) for men.

Methods

A multinational 10-surgeon expert panel collaborated towards development and validation of CASE. The critical steps of RARC in men were deconstructed into nine key domains, each assessed by five anchors. Content validation was done utilizing the Delphi methodology. Each anchor was assessed in terms of context, score concordance, and clarity. The content validity index (CVI) was calculated for each aspect. A CVI ≥ 0.75 represented consensus, and this statement was removed from the next round. This process was repeated until consensus was achieved for all statements. CASE was used to assess de-identified videos of RARC to determine reliability and construct validity. Linearly weighted percent agreement was used to assess inter-rater reliability (IRR). A logit model for odds ratio (OR) was used to assess construct validation.

Results

The expert panel reached consensus on CASE after four rounds. The final eight domains of the CASE included: pelvic lymph node dissection, development of the peri-ureteral space, lateral pelvic space, anterior rectal space, control of the vascular pedicle, anterior vesical space, control of the dorsal venous complex, and apical dissection. IRR > 0.6 was achieved for all eight domains. Experts outperformed trainees across all domains.

Conclusion

We developed and validated a reliable structured, procedure-specific tool for objective evaluation of surgical performance during RARC. CASE may help differentiate novice from expert performances.

Keywords

Robot-assisted Radical cystectomy Training Skill acquisition Quality Assessment 

Notes

Funding

This research was supported in part by funding from the National Cancer Institute of the National Institutes of Health under Award Number: R25CA181003, and Roswell Park Alliance Foundation.

Compliance with ethical standards

Disclosures

Ronney Abaza: Research grant from Intuitive Surgical. Ahmed A. Hussein, Kevin J. Sexton, Paul R. May, Maxwell V. Meng, Abolfazl Hosseini, Daniel D. Eun, Siamak Daneshmand, Bernard H. Bochner, James O. Peabody, Eila C. Skinner, Richard E. Hautmann, Khurshid A. Guru have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Ahmed A. Hussein
    • 1
    • 2
  • Kevin J. Sexton
    • 1
  • Paul R. May
    • 1
  • Maxwell V. Meng
    • 3
  • Abolfazl Hosseini
    • 4
  • Daniel D. Eun
    • 5
  • Siamak Daneshmand
    • 6
  • Bernard H. Bochner
    • 7
  • James O. Peabody
    • 8
  • Ronney Abaza
    • 9
  • Eila C. Skinner
    • 10
  • Richard E. Hautmann
    • 11
  • Khurshid A. Guru
    • 1
  1. 1.Department of UrologyRoswell Park Cancer InstituteBuffaloUSA
  2. 2.Cairo UniversityCairoEgypt
  3. 3.University of CaliforniaSan FranciscoUSA
  4. 4.Karolinska University HospitalStockholmSweden
  5. 5.Temple University HospitalPhiladelphiaUSA
  6. 6.University of Southern CaliforniaLos AngelesUSA
  7. 7.Memorial Sloan Kettering Cancer CenterNew YorkUSA
  8. 8.Henry Ford Health SystemsDetroitUSA
  9. 9.OhioHealthDublinUSA
  10. 10.Stanford UniversityPalo AltoUSA
  11. 11.University of UlmUlmGermany

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