Browsing by Author "Daneshmand, Siamak"

Now showing 1 - 4 of 4
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    An Assessment Tool to Provide Targeted Feedback to Robotic Surgical Trainees: Development and Validation of the End-to-End Assessment of Suturing Expertise (EASE)
    (American Urological Association, 2022-11) Haque, Taseen F.; Hui, Alvin; You, Jonathan; Ma, Runzhuo; Nguyen, Jessica H.; Lei, Xiaomeng; Cen, Steven; Aron, Monish; Collins, Justin W.; Djaladat, Hooman; Ghazi, Ahmed; Yates, Kenneth A.; Abreu, Andre L.; Daneshmand, Siamak; Desai, Mihir M.; Goh, Alvin C.; Hu, Jim C.; Lebastchi, Amir H.; Lendvay, Thomas S.; Porter, James; Schuckman, Anne K.; Sotelo, Rene; Sundaram, Chandru P.; Gill, Inderbir S.; Hung, Andrew J.; Urology, School of Medicine
    Purpose: To create a suturing skills assessment tool that comprehensively defines criteria around relevant sub-skills of suturing and to confirm its validity. Materials and Methods: 5 expert surgeons and an educational psychologist participated in a cognitive task analysis (CTA) to deconstruct robotic suturing into an exhaustive list of technical skill domains and sub-skill descriptions. Using the Delphi methodology, each CTA element was systematically reviewed by a multi-institutional panel of 16 surgical educators and implemented in the final product when content validity index (CVI) reached ≥0.80. In the subsequent validation phase, 3 blinded reviewers independently scored 8 training videos and 39 vesicourethral anastomoses (VUA) using EASE; 10 VUA were also scored using Robotic Anastomosis Competency Evaluation (RACE), a previously validated, but simplified suturing assessment tool. Inter-rater reliability was measured with intra-class correlation (ICC) for normally distributed values and prevalence-adjusted bias-adjusted Kappa (PABAK) for skewed distributions. Expert (≥100 prior robotic cases) and trainee (<100 cases) EASE scores from the non-training cases were compared using a generalized linear mixed model. Results: After two rounds of Delphi process, panelists agreed on 7 domains, 18 sub-skills, and 57 detailed sub-skill descriptions with CVI ≥ 0.80. Inter-rater reliability was moderately high (ICC median: 0.69, range: 0.51-0.97; PABAK: 0.77, 0.62-0.97). Multiple EASE sub-skill scores were able to distinguish surgeon experience. The Spearman’s rho correlation between overall EASE and RACE scores was 0.635 (p=0.003). Conclusions: Through a rigorous CTA and Delphi process, we have developed EASE, whose suturing sub-skills can distinguish surgeon experience while maintaining rater reliability.
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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.
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    Practice Makes Perfect: The Rest of the Story in Testicular Cancer as a Model Curable Neoplasm
    (American Society of Clinical Oncology, 2017-11-01) Tandstad, Torgrim; Kollmannsberger, Christian K.; Roth, Bruce J.; Jeldres, Claudio; Gillessen, Silke; Fizazi, Karim; Daneshmand, Siamak; Lowrance, William T.; Hanna, Nasser H.; Albany, Costantine; Foster, Richard; Cedermark, Gabriella Cohn; Feldman, Darren R.; Powles, Thomas; Lewis, Mark A.; Grimison, Peter Scott; Bank, Douglas; Porter, Christopher; Albers, Peter; De Santis, Maria; Srinivas, Sandy; Bosl, George J.; Nichols, Craig R.; Medicine, School of Medicine
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    Racial Differences in the Detection Rate of Bladder Cancer Using Blue Light Cystoscopy: Insights from a Multicenter Registry
    (MDPI, 2024-03-24) Ladi-Seyedian, Seyedeh-Sanam; Ghoreifi, Alireza; Konety, Badrinath; Pohar, Kamal; Holzbeierlein, Jeffrey M.; Taylor, John; Kates, Max; Willard, Brian; Taylor, Jennifer M.; Liao, Joseph C.; Kaimakliotis, Hristos Z.; Porten, Sima P.; Steinberg, Gary D.; Tyson, Mark D.; Lotan, Yair; Daneshmand, Siamak; Blue Light Cystoscopy with Cysview Registry Group; Urology, School of Medicine
    The use of blue light cystoscopy (BLC) has been shown to improve bladder tumor detection. However, data demonstrating the efficacy of BLC across different races are limited. Herein, we aim to evaluate heterogeneity in the characteristics of BLC for the detection of malignant lesions among various races. Clinicopathologic information was collected from patients enrolled in the multi-institutional Cysview® registry (2014-2021) who underwent transurethral resection or biopsy of bladder tumors. Outcome variables included sensitivity and negative and positive predictive values of BLC and white light cystoscopy (WLC) for the detection of malignant lesions among various races. Overall, 2379 separate lesions/tumors were identified from 1292 patients, of whom 1095 (85%) were Caucasian, 96 (7%) were African American, 51 (4%) were Asian, and 50 (4%) were Hispanic. The sensitivity of BLC was higher than that of WLC in the total cohort, as well as in the Caucasian and Asian subgroups. The addition of BLC to WLC increased the detection rate by 10% for any malignant lesion in the total cohort, with the greatest increase in Asian patients (18%). Additionally, the positive predictive value of BLC was highest in Asian patients (94%), while Hispanic patients had the highest negative predictive value (86%). Our study showed that regardless of race, BLC increases the detection of bladder cancer when combined with WLC.