Development and validation of an objective scoring tool to evaluate surgical dissection: Dissection Assessment for Robotic Technique (DART).

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.
Competing Interests: Conflicts of interest/Competing interests: M Aron has financial disclosures with Intuitive. JW Davis is a consultant for Intuitive Surgical and Janssen. MM Desai is a consultant for Auris Health, PROCEPT BioRobotics. AC Goh is a consultant for Medtronic. R Kimmig has financial disclosures with Intuitive Surgical Inc., Medtronic, Avatera, CMR and Medicaroid. J Porter is a consultant for Medtronic, Ceevra, Proximie, Intuitive. I Gill is an unpaid advisor for Steba Biotech. AJ Hung is a consultant for Mimic Technologies, Quantagene, and Johnson & Johnson. The study was not funded by any of these companies. Other authors have no conflict of interest.