Linking surgical skills to postoperative outcomes: a Delphi study on the robot-assisted radical prostatectomy
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To develop an assessment instrument for the evaluation of surgical videos to elucidate the association between surgical skills and postoperative outcomes after a robot-assisted radical prostatectomy (RARP).
A Delphi study consisting of two consecutive online surveys and a consensus group meeting.
Urology departments of general, teaching and university hospitals in the Netherlands.
All Dutch urologists with a specialization in RARP.
Of 18 invited experts, 12 (67%) participated in the first online survey. In the second round, 9 of the 18 invited experts participated (50%). The Delphi meeting was attended by 5 of the 18 (27%) invited experts. The panel identified seven surgical steps with a possible association to postoperative outcomes. The experts also expected an association between adverse postoperative outcomes and the frequency of camera removals, the number of stitches placed, the amount of bleeding, and the extent of coagulation. These factors were incorporated into an assessment instrument.
Experts in the field of RARP achieved consensus on 7 surgical steps and 4 aspects of the RARP procedure that may be related to adverse postoperative outcomes. The resulting assessment instrument will be tested in future research to determine its validity.
KeywordsDelphi RARP Video analysis Prostatectomy Surgical skills Postoperative outcomes
The authors thank H.P. Beerlage, A.E. Boeken Kruger, J.B.W. Rietbergen, J.P.M. Sedelaar, P.C. Weijerman, M.B. Busstra, O.S. Klaver, and B.C. Knipscheer for their participation during the Delphi process.
Compliance with ethical standards
Conflict of interest
Drs. Beulens, Dr. Brinkman, Dr. van der Poel, Dr. Vis, Dr. van Basten, Dr. Meijer, Dr. Wijburg, Dr. Hendrikx, Prof. van Merrienboer,, and Prof. Wagner have no conflicts of interest or financial ties to disclose.
- 1.Barocas DA, Alvarez J, Resnick MJ, Koyama T, Hoffman KE, Tyson MD, Conwill R, McCollum D, Cooperberg MR, Goodman M, Greenfield S, Hamilton AS, Hashibe M, Kaplan SH, Paddock LE, Stroup AM, Wu X-C, Penson DF (2017) Association between radiation therapy, surgery, or observation for localized prostate cancer and patient-reported outcomes after 3 years. JAMA 317(11):1126CrossRefGoogle Scholar
- 2.Donovan JL, Hamdy FC, Lane JA, Mason M, Metcalfe C, Walsh E, Blazeby JM, Peters TJ, Holding P, Bonnington S, Lennon T, Bradshaw L, Cooper D, Herbert P, Howson J, Jones A, Lyons N, Salter E, Thompson P et al (2016) Patient-reported outcomes after monitoring, surgery, or radiotherapy for prostate cancer. N Engl J Med 375(15):1425–1437CrossRefGoogle Scholar
- 3.Lardas M, Liew M, van den Bergh RC, De Santis M, Bellmunt J, Van den Broeck T, Cornford P, Cumberbatch MG, Fossati N, Gross T, Henry AM, Bolla M, Briers E, Joniau S, Lam TB, Mason MD, Mottet N, van der Poel HG, Rouvière O et al (2017) Quality of life outcomes after primary treatment for clinically localised prostate cancer: a systematic review. Eur Urol 72(6):869–885CrossRefGoogle Scholar
- 4.Maike HJ, Cathelijne MP, Ziedses des Plantes DM, Somford JA, van Erkelens RG, de Vries KH, Jozette JC, Bart P (2011) Wijsman MBB en J van L. Hoe vaak incontinentie na radicale prostatectomie? Ned Tijdschr Geneeskd 162:D2294Google Scholar
- 5.Wilson LC, Gilling PJ. Post-prostatectomy urinary incontinence: a review of surgical treatment options. BJU Int 107:7–10Google Scholar
- 13.Goldenberg MG, Lee JY, Kwong JC, Grantcharov TP, Costello A (2018) Implementing assessments of robotic-assisted technical skill in urologic education: a systematic review and synthesis of the validity evidence. BJU IntGoogle Scholar
- 15.Hussein AA, Ghani KR, Peabody J, Sarle R, Abaza R, Eun D, Hu J, Fumo M, Lane B, Montgomery JS, Hinata N, Rooney D, Comstock B, Chan HK, Mane SS, Mohler JL, Wilding G, Miller D, Guru KA (2017) Development and validation of an objective scoring tool for robot-assisted radical prostatectomy: prostatectomy assessment and competency evaluation. J Urol 197(5):1237–1244CrossRefGoogle Scholar
- 18.Gillessen S, Attard G, Beer TM, Beltran H, Bossi A, Bristow R, Carver B, Castellano D, Chung BH, Clarke N, Daugaard G, Davis ID, de Bono J, Borges dos Reis R, Drake CG, Eeles R, Efstathiou E, Evans CP, Fanti S et al (2018) Management of patients with advanced prostate cancer: the report of the advanced prostate cancer consensus conference APCCC 2017. Eur Urol 73(2):178–211CrossRefGoogle Scholar
- 19.van den Bos W, Muller BG, Ahmed H, Bangma CH, Barret E, Crouzet S, Eggener SE, Gill IS, Joniau S, Kovacs G, Pahernik S, de la Rosette JJ, Rouvière O, Salomon G, Ward JF, Scardino PT (2014) Focal therapy in prostate cancer: international multidisciplinary consensus on trial design. Eur Urol 65(6):1078–1083CrossRefGoogle Scholar
- 21.MacLennan S, Bekema HJ, Williamson PR, Campbell MK, Stewart F, MacLennan SJ, N’Dow JM, Lam TB (2015) A core outcome set for localised prostate cancer effectiveness trials: protocol for a systematic review of the literature and stakeholder involvement through interviews and a Delphi survey. Trials 16(1):76CrossRefGoogle Scholar
- 22.Fitch K, Bernstein SJJ, Aguilar MDD, Burnand B, LaCalle JRR, Lazaro P, Van Het Loo M, Mcdonnell J, Vader JPP, Kahan JPP, Loo M (2001) The RAND/UCLA appropriateness Method User’ s Manual [Internet]. TransformationGoogle Scholar
- 23.Kong H, West S (2013) WMA declaration of Helsinki—ethical principles for scientific requirements and research protocols 29–32Google Scholar