Development and validation of cystectomy assessment and surgical evaluation (CASE) scoring for male radical cystectomy
Aly AAH, Sexton KJ, Meng MV, Hosseini A, Wiklund P, Eun DD, Daneshmand S, Bochner B, Peabody JO, Abaza R, Skinner EC, Hautmann R, and Guru KA. Development and validation of cystectomy assessment and surgical evaluation (CASE) scoring for male radical cystectomy. Can Urol Assoc J 2017; 11(9):S316.
Can Urol Assoc J
Introduction: It is vital to ensure standardization and objective feedback during training and skill acquisition for optimal surgical outcomes and patient safety. We aimed to develop a structured scoring tool, Cystectomy Assessment and Surgical Evaluation (CASE), which objectively measures and quantifies performance during radical cystectomy (RC) for men. Methods: A multinational expert panel (11 surgeons who perform open and/or robot-assisted radical cystectomy [RARC]) collaborated towards development and content validation of the male RC scoring system. The critical steps of male RC were deconstructed into nine key domains, where each domain was assessed by five anchors evaluating surgical principles, technical proficiency, and safety. Content validation was done using the Delphi methodology. Each anchor statement was assessed in terms of three aspects: contextual relevance, concordance between language used and anchor score, and clarity of wording. An independent coordinator collated the comments from the expert panel and computed the Content Validity Index (CVI) for each aspect of each anchor. If CVI was ≥0.75, consensus was reached and the statement was removed from the next round. If consensus was not achieved, the coordinator incorporated the comments from the panel and the updated scoring system was redistributed. This process was repeated until consensus was achieved for all statements. All experts were blinded to each other's assessment. Results: The expert panel reached consensus after four rounds on all aspects, including language, relevance of skills assessed, and concordance between the language used and the skill assessed. A ninth domain assessing disposition of tissue was removed from the system after the second round. CVI ≥0.75 was achieved in eight (11%) statements in the first round, 44 (61%) statements in the second, 17 (24%) statements in the third, and three (4%) statements in the fourth round. The final eight domains of the CASE include: pelvic lymph node dissection, development of the periureteral space, lateral pelvic space, anterior rectal space, control of the vascular pedicle, anterior vesical space, control of the dorsal venous complex, and apical dissection. Conclusions: We developed and validated a scoring system for RC that can provide structured feedback for surgical quality assessment, training, and feedback. Validation of the scoring system is in process.