Department of Urology, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY, 14263, USA.
Cairo University, Cairo, Egypt.
Surg Endosc. 2018 Nov;32(11):4458-4464. doi: 10.1007/s00464-018-6191-3. Epub 2018 Apr 13.
We aimed to develop a structured scoring tool: cystectomy assessment and surgical evaluation (CASE) that objectively measures and quantifies performance during robot-assisted radical cystectomy (RARC) for men.
A multinational 10-surgeon expert panel collaborated towards development and validation of CASE. The critical steps of RARC in men were deconstructed into nine key domains, each assessed by five anchors. Content validation was done utilizing the Delphi methodology. Each anchor was assessed in terms of context, score concordance, and clarity. The content validity index (CVI) was calculated for each aspect. A CVI ≥ 0.75 represented consensus, and this statement was removed from the next round. This process was repeated until consensus was achieved for all statements. CASE was used to assess de-identified videos of RARC to determine reliability and construct validity. Linearly weighted percent agreement was used to assess inter-rater reliability (IRR). A logit model for odds ratio (OR) was used to assess construct validation.
The expert panel reached consensus on CASE after four rounds. The final eight domains of the CASE included: pelvic lymph node dissection, development of the peri-ureteral space, lateral pelvic space, anterior rectal space, control of the vascular pedicle, anterior vesical space, control of the dorsal venous complex, and apical dissection. IRR > 0.6 was achieved for all eight domains. Experts outperformed trainees across all domains.
We developed and validated a reliable structured, procedure-specific tool for objective evaluation of surgical performance during RARC. CASE may help differentiate novice from expert performances.
我们旨在开发一种结构化评分工具：膀胱切除术评估和手术评估（CASE），该工具可客观测量和量化男性机器人辅助根治性膀胱切除术（RARC）期间的手术表现。
一个由 10 名外科医生组成的多国家专家小组合作开发和验证 CASE。将男性 RARC 的关键步骤分解为九个关键领域，每个领域由五个锚定物进行评估。内容验证采用 Delphi 方法进行。根据上下文、评分一致性和清晰度对每个锚定物进行评估。计算每个方面的内容效度指数（CVI）。CVI≥0.75 表示达成共识，该语句将从下一轮中删除。此过程重复进行，直到所有语句均达成共识。使用 CASE 评估 RARC 的去识别视频，以确定可靠性和结构有效性。使用线性加权百分比一致性来评估评分者间可靠性（IRR）。使用胜算比（OR）的对数模型来评估结构有效性。
专家小组经过四轮达成了 CASE 的共识。CASE 的最终八个领域包括：盆腔淋巴结清扫术、输尿管周围空间的发展、侧盆空间、前直肠空间、血管蒂的控制、前膀胱空间、背静脉复合体的控制和顶部解剖。所有八个领域的 IRR 均>0.6。专家在所有领域的表现均优于学员。
我们开发并验证了一种可靠的、结构化的、针对 RARC 期间手术表现的客观评估的特定手术工具。CASE 可能有助于区分新手和专家的表现。
