title: Development, validation and clinical application of Pelvic Lymphadenectomy Assessment and Completion Evaluation: intraoperative assessment of lymph node dissection after robot-assisted radical cystectomy for bladder cancer.
abstract: To develop a scoring tool, Pelvic Lymphadenectomy Appropriateness and Completion Evaluation (PLACE), to assess the intraoperative completeness and appropriateness of pelvic lymph node dissection (PLND) following robot-assisted radical cystectomy (RARC).
  
  
  
  A panel of 11 open and robotic surgeons developed the content and structure of PLACE. The PLND template was divided into three zones. In all, 21 de-identified videos of bilateral robot-assisted PLNDs were assessed by the 11 experts using PLACE to determine inter-rater reliability. Lymph node (LN) clearance was defined as the proportion of cleared LNs from all PLACE zones. We investigated the correlation between LN clearance and LN count. Then, we compared the LN count of 18 prospective PLNDs using PLACE with our retrospective series performed using the extended template (No PLACE).
  
  
  
  A significant reliability was achieved for all PLACE zones among the 11 raters for the 21 bilateral PLND videos. The median (interquartile range) for LN clearance was 468 (431-545). There was a significant positive correlation between LN clearance and LN count (R2= 0.70, P < 0.01). The PLACE group yielded similar LN counts when compared to the No PLACE group.
  
  
  
  Pelvic Lymphadenectomy Appropriateness and Completion Evaluation is a structured intraoperative scoring system that can be used intraoperatively to measure and quantify PLND for quality control and to facilitate training during RARC.
authors.affiliation: Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA.|Department of Urology, Cairo University, Cairo, Egypt.
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Hussein
authors.affiliation: Department of Urology, University of Kobe, Kobe, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Hinata
authors.affiliation: Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: Shiva
authors.initials: S
authors.lastname: Dibaj
authors.affiliation: Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: Paul R
authors.initials: PR
authors.lastname: May
authors.affiliation: Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: Justen D
authors.initials: JD
authors.lastname: Kozlowski
authors.affiliation: Department of Urology and Nephrology, Mansoura University, Mansoura, Egypt.
authors.forename: Hassan
authors.initials: H
authors.lastname: Abol-Enein
authors.affiliation: OhioHealth Robotic Surgery, Dublin, OH, USA.
authors.forename: Ronney
authors.initials: R
authors.lastname: Abaza
authors.affiliation: Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Eun
authors.affiliation: Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA.
authors.forename: Mohamed S
authors.initials: MS
authors.lastname: Khan
authors.affiliation: Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: James L
authors.initials: JL
authors.lastname: Mohler
authors.affiliation: Ohio State University, Columbus, OH, USA.
authors.forename: Piyush
authors.initials: P
authors.lastname: Agarwal
authors.affiliation: Michigan Institute of Urology, Dearborn, MI, USA.
authors.forename: Kamal
authors.initials: K
authors.lastname: Pohar
authors.affiliation: Indiana University, Indianapolis, IN, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Sarle
authors.affiliation: Guy's and St Thomas' NHS Foundation Trust and King's College School of Medicine, London, UK.
authors.forename: Ronald
authors.initials: R
authors.lastname: Boris
authors.affiliation: Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: Sridhar S
authors.initials: SS
authors.lastname: Mane
authors.affiliation: Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Hutson
authors.affiliation: Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: Khurshid A
authors.initials: KA
authors.lastname: Guru
mesh_terms: D000328:Adult; D015653:Cystectomy / Q000379:methods*; D006801:Humans; D007430:Intraoperative Care; D008197:Lymph Node Excision; D008875:Middle Aged; D063868:Patient Outcome Assessment; D010388:Pelvis; D011446:Prospective Studies; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D001749:Urinary Bladder Neoplasms / Q000601:surgery*
keywords: #BladderCancer; #blcsm; lymph node dissection; lymphadenectomy; quality; radical cystectomy; robot-assisted