Ahmed A Hussein1, Khurshid R Ghani2, James Peabody3, Richard Sarle4, Ronney Abaza5, Daniel Eun6, Jim Hu7, Michael Fumo8, Brian Lane9, Jeffrey S Montgomery2, Nobuyuki Hinata10, Deborah Rooney11, Bryan Comstock12, Hei Kit Chan13, Sridhar S Mane13, James L Mohler13, Gregory Wilding13, David Miller2, Khurshid A Guru14. 1. Department of Urology, Roswell Park Cancer Institute, Buffalo, New York; Department of Urology, Cairo University, Cairo, Egypt. 2. Department of Urology, University of Michigan, Ann Arbor, Michigan. 3. Henry Ford Health System, Detroit, Michigan. 4. Michigan Institute of Urology, Dearborn, Michigan. 5. OhioHealth, Dublin, Ohio. 6. Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania. 7. Weil Cornell Medicine, New York, New York. 8. Henry Ford Medical Group, Detroit, Michigan. 9. Spectrum Health Medical, Grand Rapids, Michigan. 10. University of Kobe, Kobe, Japan. 11. Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan. 12. University of Washington, Seattle, Washington. 13. Department of Urology, Roswell Park Cancer Institute, Buffalo, New York. 14. Department of Urology, Roswell Park Cancer Institute, Buffalo, New York. Electronic address: Khurshid.guru@roswellpark.org.
Abstract
PURPOSE: Comprehensive training and skill acquisition by urological surgeons are vital to optimize surgical outcomes and patient safety. We sought to develop and validate PACE (Prostatectomy Assessment and Competence Evaluation), an objective and procedure specific tool to assess the quality of robot-assisted radical prostatectomy. MATERIALS AND METHODS: Development and content validation of PACE was performed by deconstructing robot-assisted radical prostatectomy into 7 key domains utilizing the Delphi methodology. Reliability and construct validation were then assessed using de-identified videos performed by practicing surgeons and fellows. Consensus for each domain was defined as achieving a content validity index of 0.75 or greater. Reliability was assessed by the intraclass correlation and construct validation using a mixed linear model accounting for multiple ratings on the same video. RESULTS: After 3 rounds consensus was reached on wording, relevance of the skills assessed and concordance between the score assigned and the skill assessed. An intraclass correlation of 0.4 or greater was achieved for all domains. The expert group outperformed trainees in all domains but reached statistical significance in bladder drop (4.5 vs 3.4, p = 0.002), preparation of the prostate (4.4 vs 3.2, p <0.0001), seminal vesicle and posterior plane dissection (8.3 vs 6.8, p = 0.03), and neurovascular bundle preservation (4.1 vs 2.4, p <0.0001). Limitations included the lack of assessment of other key skills such as communication and decision making. CONCLUSIONS: PACE is a structured, procedure specific and reliable tool that objectively measures surgical performance during robot-assisted radical prostatectomy. It can differentiate different levels of expertise and provide structured feedback to customize training and surgical quality improvement.
PURPOSE: Comprehensive training and skill acquisition by urological surgeons are vital to optimize surgical outcomes and patient safety. We sought to develop and validate PACE (Prostatectomy Assessment and Competence Evaluation), an objective and procedure specific tool to assess the quality of robot-assisted radical prostatectomy. MATERIALS AND METHODS: Development and content validation of PACE was performed by deconstructing robot-assisted radical prostatectomy into 7 key domains utilizing the Delphi methodology. Reliability and construct validation were then assessed using de-identified videos performed by practicing surgeons and fellows. Consensus for each domain was defined as achieving a content validity index of 0.75 or greater. Reliability was assessed by the intraclass correlation and construct validation using a mixed linear model accounting for multiple ratings on the same video. RESULTS: After 3 rounds consensus was reached on wording, relevance of the skills assessed and concordance between the score assigned and the skill assessed. An intraclass correlation of 0.4 or greater was achieved for all domains. The expert group outperformed trainees in all domains but reached statistical significance in bladder drop (4.5 vs 3.4, p = 0.002), preparation of the prostate (4.4 vs 3.2, p <0.0001), seminal vesicle and posterior plane dissection (8.3 vs 6.8, p = 0.03), and neurovascular bundle preservation (4.1 vs 2.4, p <0.0001). Limitations included the lack of assessment of other key skills such as communication and decision making. CONCLUSIONS: PACE is a structured, procedure specific and reliable tool that objectively measures surgical performance during robot-assisted radical prostatectomy. It can differentiate different levels of expertise and provide structured feedback to customize training and surgical quality improvement.
Authors: 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 Journal: Surg Endosc Date: 2018-04-13 Impact factor: 4.584
Authors: Amir Baghdadi; Ahmed A Hussein; Youssef Ahmed; Lora A Cavuoto; Khurshid A Guru Journal: Int J Comput Assist Radiol Surg Date: 2018-11-20 Impact factor: 2.924