Development and Validation of an Objective Scoring Tool to Evaluate Surgical Dissection: Dissection Assessment for Robotic Technique (DART)

Vanstrum, Erik; Ma, Runzhuo; Maya-Silva, Jacqueline; Sanford, Daniel I.; Nguyen, Jessica; Lei, Xiaomeng; Chevinksy, Michael; Ghoreifi, Alireza; Han, Jaewon; Polotti, Charles F.; Powers, Ryan; Yip, Wesley; Zhang, Michael; Aron, Monish; Collins, Justin; Daneshmand, Siamak; Davis, John W.; Desai, Mihir; Gerjy, Roger; Goh, Alvin C.; Hu, Jim C.; Lendvay, Thomas S.; Porter, James; Sotelo, René; Sundaram, Chandru P.; Cen, Steven; Gill, Inderbir S.; Hung, Andrew J.

doi:10.1097/upj.0000000000000246

Cited by 14 publications

(18 citation statements)

References 14 publications

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“…Most recently, in 2021, Vanstrum et al developed the DART (Dissection Assessment of Robotic Technique). 20 This broadly applicable 6-item tool was designed for use in robotic procedures to assess trainees’ dissection performance. It evaluates trainees’ ability to use effective gestures when dissecting (gestural level), as well as their overall dissection skills (procedural level), using a 3-point scale.…”

Section: Resultsmentioning

confidence: 99%

Current Landscape of Surgical Assessment Models in Urology Residency Training

et al. 2023

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Purpose:Assessing trainees’ surgical proficiency is an important aspect of urological surgical training. The current standard is the Urology Milestone Project, initially implemented in 2013. This evaluation is limited in that it contains only 3 questions on surgical competency per surgical modality with assessments occurring semi-annually without real-time operative feedback. However, since the Urology Milestones Project’s inception a plethora of competency-based surgical assessment tools have been described. We aim to perform a comprehensive review of the literature of these available tools and analyze their strengths and weaknesses as a way of providing a repository of available assessment strategies for further development of a more comprehensive and standardized assessment tool.Materials and Methods:A review of the primary literature was performed using key words such as “surgical assessment tools urology,” “surgical assessment tools prostate,” “bladder surgical assessment tools,” “renal surgical assessment tools urology,” and “surgical assessment tools urology task specific.” Technical and nontechnical skill assessments were included. One reviewer identified and analyzed studies that published assessment tools for use in surgical and urological training.Results:A total of 1,497 articles published between 1997-2022 were identified. Of these, 34 met the inclusion criteria. Eighteen (52.9%) were specialty nonspecific and 16 (47.1%) were specific for urological training. Of the 18 tools developed for general surgical principles, 12 (66.7%) had some form of validity, 9 (50.0%) were significantly reliable, and 2 (11.1%) were externally validated. Of the 16 tools developed specifically for use in urology training, 13 (81.3%) had some form of validity, 7 (43.8%) were significantly reliable, and none were externally validated. Of these 16 tools, 12 (75.0%) were procedure-specific and 4 (25.0%) were developed for general use in endourological procedures.Conclusions:Surgical training is evolving toward a competency-based model, as evidenced by the increase in assessment tools created within the past 10 years. These instruments not only provide objective feedback to trainees, but also monitor progression. However, they are heterogeneous in construct and utilization. There remains a need for the adoption of a standardized, valid, and reliable tool, ie, both procedure-specific and generalizable across multiple procedures for use in urology training.

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Section: Resultsmentioning

confidence: 99%

Current Landscape of Surgical Assessment Models in Urology Residency Training

et al. 2023

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“…Objectively assessing and quantifying surgery has conventionally been challenging. A common solution is to use objective assessment tools such as GEARS or DART to evaluate surgical skills [14][15][16] . Unfortunately, these tools suffer from subjectivity and do not capture surgical data at its most granular level 17 .…”

Section: Discussionmentioning

confidence: 99%

Surgical gestures as a method to quantify surgical performance and predict patient outcomes

Ramaswamy

et al. 2022

npj Digit. Med.

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How well a surgery is performed impacts a patient’s outcomes; however, objective quantification of performance remains an unsolved challenge. Deconstructing a procedure into discrete instrument-tissue “gestures” is a emerging way to understand surgery. To establish this paradigm in a procedure where performance is the most important factor for patient outcomes, we identify 34,323 individual gestures performed in 80 nerve-sparing robot-assisted radical prostatectomies from two international medical centers. Gestures are classified into nine distinct dissection gestures (e.g., hot cut) and four supporting gestures (e.g., retraction). Our primary outcome is to identify factors impacting a patient’s 1-year erectile function (EF) recovery after radical prostatectomy. We find that less use of hot cut and more use of peel/push are statistically associated with better chance of 1-year EF recovery. Our results also show interactions between surgeon experience and gesture types—similar gesture selection resulted in different EF recovery rates dependent on surgeon experience. To further validate this framework, two teams independently constructe distinct machine learning models using gesture sequences vs. traditional clinical features to predict 1-year EF. In both models, gesture sequences are able to better predict 1-year EF (Team 1: AUC 0.77, 95% CI 0.73–0.81; Team 2: AUC 0.68, 95% CI 0.66–0.70) than traditional clinical features (Team 1: AUC 0.69, 95% CI 0.65–0.73; Team 2: AUC 0.65, 95% CI 0.62–0.68). Our results suggest that gestures provide a granular method to objectively indicate surgical performance and outcomes. Application of this methodology to other surgeries may lead to discoveries on methods to improve surgery.

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“…One crucial component of high-quality simulation is objective assessment and structured feedback. Numerous assessment tools, both general and procedure-specific, have been crafted [38 ▪ ,39,40]. Traditionally, the use of these tools necessitates the examination of surgical videos by experts, a process that is labor-intensive and restricts their widespread application in training programs.…”

Section: Trends In Assessment For Simulationmentioning

confidence: 99%

Simulation training in urology

Knudsen,

Ma,

Hung

2023

Current Opinion in Urology

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Purpose of review This review outlines recent innovations in simulation technology as it applies to urology. It is essential for the next generation of urologists to attain a solid foundation of technical and nontechnical skills, and simulation technology provides a variety of safe, controlled environments to acquire this baseline knowledge. Recent findings With a focus on urology, this review first outlines the evidence to support surgical simulation, then discusses the strides being made in the development of 3D-printed models for surgical skill training and preoperative planning, virtual reality models for different urologic procedures, surgical skill assessment for simulation, and integration of simulation into urology residency curricula. Summary Simulation continues to be an integral part of the journey towards the mastery of skills necessary for becoming an expert urologist. Clinicians and researchers should consider how to further incorporate simulation technology into residency training and help future generations of urologists throughout their career.

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Development and Validation of an Objective Scoring Tool to Evaluate Surgical Dissection: Dissection Assessment for Robotic Technique (DART)

Cited by 14 publications

References 14 publications

Current Landscape of Surgical Assessment Models in Urology Residency Training

Current Landscape of Surgical Assessment Models in Urology Residency Training

Surgical gestures as a method to quantify surgical performance and predict patient outcomes

Simulation training in urology

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