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Development and validation of an objective scoring tool to evaluate surgical dissection: Dissection Assessment for
Erik B Vanstrum1, Runzhuo Ma1, Jacqueline Maya-Silva1
1Catherine & Joseph Aresty Department of Urology, Center for Robotic Simulation & Education, University of Southern California Institute of Urology, Los Angeles, CA, USA.
Urology Practice
|May 3, 2023
Summary
A new tool, Dissection Assessment for Robotic Technique (DART), objectively evaluates surgical dissection skills. This validated 3-point assessment effectively differentiates surgeon experience levels in robotic procedures.
Area of Science:
- Surgical Education and Training
- Medical Device Development
- Robotic Surgery Assessment
Background:
- Surgical competency evaluation is crucial for training, accreditation, and patient outcomes.
- A specific tool for assessing surgical dissection performance is currently lacking.
- This project focused on developing an objective measure for dissection quality.
Purpose of the Study:
- To design and validate a tool for assessing surgical dissection quality.
- To create an objective and reproducible method for evaluating dissection performance.
- To establish a reliable metric for surgical skill assessment in dissection.
Main Methods:
- The Delphi method was employed for content and structural validation by 14 expert surgeons.
- A 3-point and a 5-point scale were evaluated for their effectiveness.
- 46 de-identified videos of robot-assisted radical prostatectomy dissections were reviewed by 10 blinded experts.
- Inter-rater variability was assessed using kappa statistics, and discrimination power was analyzed using ROC curves.
Main Results:
- The Delphi method achieved validity for 27 out of 28 elements, with a 3-point scale showing improved inter-rater reliability (kappa).
- Expert surgeons consistently scored higher than trainees on both 3-point and 5-point scales (p<0.001).
- Both scales demonstrated equivalent ability to distinguish surgeon experience levels (AUC=0.92).
Conclusions:
- The Dissection Assessment for Robotic Technique (DART) is a validated, objective, and reproducible 3-point assessment tool.
- DART effectively differentiates surgeon experience in robotic procedures.
- The tool is applicable across various surgical steps requiring dissection.
