title: Development and Validation of an Objective Scoring Tool for Robot-Assisted Radical Prostatectomy: Prostatectomy Assessment and Competency Evaluation.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.affiliation: Department of Urology, Roswell Park Cancer Institute, Buffalo, New York; Department of Urology, Cairo University, Cairo, Egypt.
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Hussein
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Khurshid R
authors.initials: KR
authors.lastname: Ghani
authors.affiliation: Henry Ford Health System, Detroit, Michigan.
authors.forename: James
authors.initials: J
authors.lastname: Peabody
authors.affiliation: Michigan Institute of Urology, Dearborn, Michigan.
authors.forename: Richard
authors.initials: R
authors.lastname: Sarle
authors.affiliation: OhioHealth, Dublin, Ohio.
authors.forename: Ronney
authors.initials: R
authors.lastname: Abaza
authors.affiliation: Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania.
authors.forename: Daniel
authors.initials: D
authors.lastname: Eun
authors.affiliation: Weil Cornell Medicine, New York, New York.
authors.forename: Jim
authors.initials: J
authors.lastname: Hu
authors.affiliation: Henry Ford Medical Group, Detroit, Michigan.
authors.forename: Michael
authors.initials: M
authors.lastname: Fumo
authors.affiliation: Spectrum Health Medical, Grand Rapids, Michigan.
authors.forename: Brian
authors.initials: B
authors.lastname: Lane
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Montgomery
authors.affiliation: University of Kobe, Kobe, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Hinata
authors.affiliation: Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan.
authors.forename: Deborah
authors.initials: D
authors.lastname: Rooney
authors.affiliation: University of Washington, Seattle, Washington.
authors.forename: Bryan
authors.initials: B
authors.lastname: Comstock
authors.affiliation: Department of Urology, Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: Hei Kit
authors.initials: HK
authors.lastname: Chan
authors.affiliation: Department of Urology, Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: Sridhar S
authors.initials: SS
authors.lastname: Mane
authors.affiliation: Department of Urology, Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: James L
authors.initials: JL
authors.lastname: Mohler
authors.affiliation: Department of Urology, Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: Gregory
authors.initials: G
authors.lastname: Wilding
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: David
authors.initials: D
authors.lastname: Miller
authors.affiliation: Department of Urology, Roswell Park Cancer Institute, Buffalo, New York. Electronic address: Khurshid.guru@roswellpark.org.
authors.forename: Khurshid A
authors.initials: KA
authors.lastname: Guru
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000706:statistics & numerical data*; D003697:Delphi Technique; D006801:Humans; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000601:surgery; D011468:Prostatectomy / Q000379:methods / Q000592:standards*; D011471:Prostatic Neoplasms / Q000601:surgery*; D058996:Quality Improvement; D015203:Reproducibility of Results; D065287:Robotic Surgical Procedures / Q000379:methods / Q000592:standards*
keywords: credentialing; professional competence; prostate; prostatectomy; robotics