Browsing by Author "Collins, Justin"

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    Development and validation of an objective scoring tool to evaluate surgical dissection: Dissection Assessment for Robotic Technique (DART)
    (American Urological Association Education and Research, Inc., 2021) Vanstrum, Erik B.; Ma, Runzhuo; Maya-Silva, Jacqueline; Sanford, Daniel; Nguyen, Jessica H.; Lei, Xiaomeng; Chevinksy, Michael; Ghoreifi, Alireza; Han, Jullet; Polotti, Charles F.; Powers, Ryan; Yip, Wesley; Zhang, Michael; Aron, Monish; Collins, Justin; Daneshmand, Siamak; Davis, John W.; Desai, Mihir M.; Gerjy, Roger; Goh, Alvin C.; Kimmig, Rainer; Lendvay, Thomas S.; Porter, James; Sotelo, Rene; Sundaram, Chandru P.; Cen, Steven; Gill, Inderbir S.; Hung, Andrew J.; Urology, School of Medicine
    Purpose: Evaluation of surgical competency has important implications for training new surgeons, accreditation, and improving patient outcomes. A method to specifically evaluate dissection performance does not yet exist. This project aimed to design a tool to assess surgical dissection quality. Methods: Delphi method was used to validate structure and content of the dissection evaluation. A multi-institutional and multi-disciplinary panel of 14 expert surgeons systematically evaluated each element of the dissection tool. Ten blinded reviewers evaluated 46 de-identified videos of pelvic lymph node and seminal vesicle dissections during the robot-assisted radical prostatectomy. Inter-rater variability was calculated using prevalence-adjusted and bias-adjusted kappa. The area under the curve from receiver operating characteristic curve was used to assess discrimination power for overall DART scores as well as domains in discriminating trainees (≤100 robotic cases) from experts (>100). Results: Four rounds of Delphi method achieved language and content validity in 27/28 elements. Use of 3- or 5-point scale remained contested; thus, both scales were evaluated during validation. The 3-point scale showed improved kappa for each domain. Experts demonstrated significantly greater total scores on both scales (3-point, p< 0.001; 5-point, p< 0.001). The ability to distinguish experience was equivalent for total score on both scales (3-point AUC= 0.92, CI 0.82-1.00, 5-point AUC= 0.92, CI 0.83-1.00). Conclusions: We present the development and validation of Dissection Assessment for Robotic Technique (DART), an objective and reproducible 3-point surgical assessment to evaluate tissue dissection. DART can effectively differentiate levels of surgeon experience and can be used in multiple surgical steps.