Scoring surgical skill in robotic prostatectomy as adherence to the surgical plan: proposal for a new tool (ScAPSA).

Abstract

BACKGROUND: The plethora of instruments (trifecta, pentafecta, etc.) used to evaluate the outcomes of robotic prostatectomy (RARP) has recently been subjected to criticism. In this paper, a novel approach called ScAPSA (Scoring Adherence to Prostatic Surgical Aims) is proposed to assess surgical proficiency, considering surgical success as perfect adherence to a correct surgical plan, and not related solely to clinical outcomes. METHODS: In order to define (and quantify) such adherence, and to evaluate both learning curves and surgeons' skill, a 20-point scoring system has been developed. The specific surgical plan (improved with predictive tools) is compared with pathological findings to identify any surgical errors. Adding data on postoperative complications, a score from 0 (better) to 20 (worst surgical result) can easily be calculated. Considering the number of reported cases needed to complete the RARP learning curve, we decided to analyze the first 25 consecutive single-surgeon RARPs. RESULTS: Testing ScAPSA on the first consecutive (initial learning curve) single-surgeon RARPs confirmed that this tool can faithfully describe and quantify both learning curves and surgical skill. CONCLUSIONS: ScAPSA may represent a useful novel tool, not only for describing RARP learning curves objectively, but also for determining and quantifying success rates, allowing surgeons to check intra-operative errors and monitor their own surgical proficiency. Further external validations are needed to confirm these results.