Scoring surgical skill in robotic prostatectomy as adherence to the surgical plan: proposal for a new tool (ScAPSA).
BACKGROUND
The plethora of instruments (trifecta, pentafecta, etc.) used to evaluate the outcomes of robotic prostatectomy (RARP) has recently been subjected to criticism. In this paper, a novel approach called ScAPSA (Scoring Adherence to Prostatic Surgical Aims) is proposed to assess surgical proficiency, considering surgical success as perfect adherence to a correct surgical plan, and not related solely to clinical outcomes.


METHODS
In order to define (and quantify) such adherence, and to evaluate both learning curves and surgeons' skill, a 20-point scoring system has been developed. The specific surgical plan (improved with predictive tools) is compared with pathological findings to identify any surgical errors. Adding data on postoperative complications, a score from 0 (better) to 20 (worst surgical result) can easily be calculated. Considering the number of reported cases needed to complete the RARP learning curve, we decided to analyze the first 25 consecutive single-surgeon RARPs.


RESULTS
Testing ScAPSA on the first consecutive (initial learning curve) single-surgeon RARPs confirmed that this tool can faithfully describe and quantify both learning curves and surgical skill.


CONCLUSIONS
ScAPSA may represent a useful novel tool, not only for describing RARP learning curves objectively, but also for determining and quantifying success rates, allowing surgeons to check intra-operative errors and monitor their own surgical proficiency. Further external validations are needed to confirm these results.
Section of Urology, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy - fabrizio.dalmoro@unipd.it.
Fabrizio
F
Dal Moro
Marina P
MP
Gardiman
D002983:Clinical Competence; D019091:Critical Pathways; D006801:Humans; D059032:Learning Curve; D008297:Male; D011446:Prospective Studies; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D065287:Robotic Surgical Procedures