International Expert Consensus on Metric-based Characterization of Robot-assisted Partial Nephrectomy

Area of Science:

• Urology
• Surgical Education
• Robotics

Background:

• Robot-assisted partial nephrectomy (RAPN) training lacks standardized objective assessment methods.
• Current training varies globally, hindering consistent skill evaluation before in vivo practice.
• Developing objective metrics is crucial for enhancing RAPN training and surgical outcomes.

Purpose of the Study:

• To identify objective performance metrics for robot-assisted partial nephrectomy (RAPN).
• To obtain face and content validity for these metrics from RAPN procedure experts.
• To establish a foundation for structured, quality-assured RAPN surgical training.

Main Methods:

• A core team of RAPN experts and a behavioral scientist deconstructed the RAPN procedure.
• Performance metrics were identified based on guidelines, manufacturer instructions, and surgical videos.
• A modified Delphi process with an international panel of 19 expert surgeons was used for validation.

Main Results:

• Eleven procedure phases, 64 steps, 43 errors, and 39 critical errors were identified.
• The Delphi process resulted in 13 added, 6 deleted, and 3 modified metrics.
• 100% consensus was achieved on the final set of metrics for left-sided RAPN.

Conclusions:

• Validated objective performance metrics for RAPN have been developed.
• These metrics were endorsed by an international panel of experienced surgeons.
• Reliable and valid metrics are fundamental for effective, quality-assured, structured surgical training in RAPN.