Development and Validation of an Objective Scoring Tool for Robot-Assisted Partial Nephrectomy: Scoring for Partial Nephrectomy

OBJECTIVE To develop a structured and objective scoring tool for assessment of robot assisted partial nephrectomy (RAPN): Scoring for Partial Nephrectomy (SPaN). MATERIALS AND METHODS Content development: RAPN was deconstructed into 6 domains by a multi-institutional panel of 10 expert robotic surgeons. Performance on each domain was represented on a Likert scale of 1-5, with specific descriptions of anchors 1, 3 and 5. Content validation: The Delphi methodology was utilized to achieve consensus about the description of each anchor for each domain in terms of appropriateness of the skill assessed, objectiveness, clarity, and unambiguous wording. The content validity index (CVI) of ≥0.75 was set as cut-off for consensus. Reliability: 15 de-identified videos of RAPN were utilized to determine the inter-rater reliability using linearly weighted percent agreement, and Construct validation of SPaN was described in terms of median scores and odds ratios. RESULTS The expert panel reached consensus (CVI ≥ 0.75) after 2 rounds. Consensus was achieved for 36 (67%) statements in the first round and 18 (33%) after the second round. The final six-domain SPaN included: Exposure of the kidney; Identification and dissection of the ureter and gonadal vessels; Dissection of the hilum; Tumor localization and exposure; Clamping and tumor resection; and Renorrhaphy. The linearly weighted percent agreement was > 0.75 for all domains. There was no difference between median scores for any domain between attendings and trainees. CONCLUSION Despite the lack of signification construct validity, SPaN is a structured, reliable and procedure-specific tool that can objectively assesses technical proficiency for RAPN.