Development and Validation of an Objective Scoring Tool for Robot-Assisted Radical Prostatectomy: Prostatectomy Assessment and Competency Evaluation: Beyond the Abstract

What defines surgical competency? The number of procedures performed or console hours have been used as a surrogate measure for technical proficiency. However, their reliability as a measure for competency remains questionable, especially with wide variation in the procedures performed and their frequency. Survival outcomes do not reliably measure surgical performance. Many factors such as primarily disease stage, patient comorbidities and technical complexity affect survival.

The Best Practice statement by The American Urological Association (AUA) endorses the need for validated assessment tools for robotic technical proficiency and credentialing for radical prostatectomy. Such tools should provide objective assessment of general as well as procedure-specific robot-assisted skills and ensure adequate training that allows graduation of competent surgeons capable of delivering safe care. Prostatectomy Assessment and Competency Evaluation (PACE) is a procedure-specific scoring system for robot-assisted radical prostatectomy developed and validated by using robust methodology and by consensus among high volume surgical experts.

Modular training has been shown effective as means of step-wise transfer of technically challenging surgical skills to trainees. PACE combines the principles of modular training and the ability to provide objective evaluation and quantification of surgical performance thereby providing structural feedback. Progress of trainees can be monitored while providing constructive evaluation that guides and tailors training activities. The Applied Technology Laboratory for Advanced Surgery (ATLAS) program at Roswell Park Cancer Institute (RPCI) has already explored various methods to optimize the modern surgical armamentarium. Cognitive assessment of trainees and mentors during surgery and evaluation of functional brain states during surgery may uncover the complex process of learning, surgical skills-acquisition and the cognitive milieu. Assessment of the operative room environment (leadership, teamwork, team interactions and communications) is of no less importance. This multidisciplinary approach for surgical education opens new horizons for optimal skill acquisition, surgical education and ultimately patient safety.

On behalf of the authors, The Applied Technology Laboratory for Advanced Surgery (ATLAS) program and The Michigan Urological Surgery Improvement Collaborative (MUSIC):

Written by: Ahmed Aly Hussein, MD and Khurshid A. Guru, MD