Surgical Competency for Urethrovesical Anastomosis During Robot-assisted Radical Prostatectomy: Development and Validation of the Robotic Anastomosis Competency Evaluation


      To develop and validate an assessment tool for the performance of urethrovesical anastomosis (UVA).


      A multicenter, prospective, observational study was conducted in 2 phases. Phase 1, development and content validation, used a panel of 5 experienced robotic surgeons to develop a 6-domain scoring system, Robotic Anastomosis Competence Evaluation (RACE), to assess technical skills for performing UVA. Phase 2, construct validation and reliability, used 5 blinded experienced robotic surgeons to rate UVA recordings of expert, advanced beginner, and novice groups. Content validation index was determined to report consensus in phase 1. Phase 2 involved comparison of RACE scores among the 3 groups. Wilcoxon rank-sum tests were used to compare RACE scores.


      Two rounds of Delphi methodology achieved consensus on language and content of RACE. Eight experts, 10 advanced beginners, and 10 novice robotic surgeons participated in the validation study. The overall score for the expert group (27.3) was higher than that of the advanced beginner (19.5; P = .04) and novice groups (13.6; P = .001). The advanced beginner and novice groups differed in overall scores (P = .03).


      RACE allows evaluation of surgical competence to perform UVA for robot-assisted radical prostatectomy, when using an inanimate model.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Schenarts P.J.
        • Flowers K.
        Too many excuses for not teaching in the operating room and one simple solution: faculty feedback.
        JAMA Surg. 2013; 148: 923
        • Buffi N.
        • Van Der Poel H.
        • Guazzoni G.
        • Mottrie A.
        Methods and priorities of robotic surgery training program.
        Eur Urol. 2014; 65: 1-2
        • Samadi D.B.
        • Muntner P.
        • Nabizada-Pace F.
        • et al.
        Improvements in robot-assisted prostatectomy: the effect of surgeon experience and technical changes on oncologic and functional outcomes.
        J Endourol. 2010; 24: 1105-1110
        • Skolarus T.A.
        • Hedgepeth R.C.
        • Zhang Y.
        • et al.
        Does robotic technology mitigate the challenges of large prostate size?.
        Urology. 2010; 76: 1117-1121
        • Ficarra V.
        • Novara G.
        • Rosen R.C.
        • et al.
        Systematic review and meta-analysis of studies reporting urinary continence recovery after robot-assisted radical prostatectomy.
        Eur Urol. 2012; 62: 405-417
        • Tyritzis S.I.
        • Katafigiotis I.
        • Constantinides C.A.
        All you need to know about urethrovesical anastomotic urinary leakage following radical prostatectomy.
        J Urol. 2012; 188: 369-376
        • Mochtar C.A.
        • Kauer P.C.
        • Laguna M.P.
        • et al.
        Urinary leakage after laparoscopic radical prostatectomy: a systematic review.
        J Endourol. 2007; 21: 1371-1379
        • Ricchiuti D.
        • Cerone J.
        • Shie S.
        • et al.
        Diminished suture strength after robotic needle driver manipulation.
        J Endourol. 2010; 24: 1509-1513
        • Boon J.R.
        • Salas N.
        • Avila D.
        • et al.
        Construct validity of the pig intestine model in the simulation of laparoscopic urethrovesical anastomosis: tools for objective evaluation.
        J Endourol. 2008; 22: 2713-2716
        • Yang R.M.
        • Bellman G.C.
        Laparoscopic urethrovesical anastomosis: a model to assess surgical competency.
        J Endourol. 2006; 20: 679-682
        • Chowriappa A.R.
        • Raza S.J.
        • Fazili A.
        • et al.
        Augmented-reality-based skills training for robot-assisted urethrovesical anastomosis: a multi-institutional randomised controlled trial.
        BJU Int. 2014;
        • Polit D.F.
        • Beck C.T.
        • Owen S.V.
        Is the CVI an acceptable indicator of content validity? Appraisal and recommendations.
        Res Nurs Health. 2007; 30: 459-467
        • Stegemann A.P.
        • Ahmed K.
        • Syed J.R.
        • et al.
        Fundamental skills of robotic surgery: a multi-institutional randomized controlled trial for validation of a simulation-based curriculum.
        Urology. 2013; 81: 767-774
        • Dreyfus S.E.
        • Dreyfus H.L.
        A Five-stage Model of the Mental Activities Involved in Directed Skill Acquisition.
        Storming Media, Washington, DC1980 (Retrieved Aug 23rd, 2014)
        • Goh A.C.
        • Goldfarb D.W.
        • Sander J.C.
        • et al.
        Global evaluative assessment of robotic skills: validation of a clinical assessment tool to measure robotic surgical skills.
        J Urol. 2012; 187: 247-252
        • Vickers A.
        • Savage C.
        • Bianco F.
        • et al.
        Cancer control and functional outcomes after radical prostatectomy as markers of surgical quality: analysis of heterogeneity between surgeons at a single cancer center.
        Eur Urol. 2011; 59: 317-322
        • Vickers A.
        • Eastham J.
        What has to happen before we report radical prostatectomy outcomes of individual surgeons to the public?.
        Urol Oncol. 2011; 29: 118-123
        • Ahmed K.
        • Miskovic D.
        • Darzi A.
        • et al.
        Observational tools for assessment of procedural skills: a systematic review.
        Am J Surg. 2011; 202: 469-480
        • Kurashima Y.
        • Feldman L.S.
        • Al-Sabah S.
        • et al.
        A tool for training and evaluation of laparoscopic inguinal hernia repair: the Global Operative Assessment Of Laparoscopic Skills-Groin Hernia (GOALS-GH).
        Am J Surg. 2011; 201: 54-61
        • Palter V.N.
        • MacRae H.M.
        • Grantcharov T.P.
        Development of an objective evaluation tool to assess technical skill in laparoscopic colorectal surgery: a Delphi methodology.
        Am J Surg. 2011; 201: 251-259
        • Zevin B.
        • Bonrath E.M.
        • Aggarwal R.
        • et al.
        Development, feasibility, validity, and reliability of a scale for objective assessment of operative performance in laparoscopic gastric bypass surgery.
        J Am Coll Surg. 2013; 216 (quiz 1029-31, 33): 955-965.e8
        • Anderson C.I.
        • Gupta R.N.
        • Larson J.R.
        • et al.
        Impact of objectively assessing surgeons' teaching on effective perioperative instructional behaviors.
        JAMA Surg. 2013; 148: 915-922
        • Birkmeyer J.D.
        • Finks J.F.
        • O'Reilly A.
        • et al.
        Surgical skill and complication rates after bariatric surgery.
        N Engl J Med. 2013; 369: 1434-1442
        • Schlomm T.
        • Huland H.
        • Graefen M.
        Improving outcome of surgical procedures is not possible without adequate quality measurement.
        Eur Urol. 2014; 65: 1017-1019
        • Stolzenburg J.U.
        • Rabenalt R.
        • Do M.
        • et al.
        Modular training for residents with no prior experience with open pelvic surgery in endoscopic extraperitoneal radical prostatectomy.
        Eur Urol. 2006; 49 (discussion 9-500): 491-498
        • Carter S.C.
        • Chiang A.
        • Shah G.
        • et al.
        Video-based peer feedback through social networking for robotic surgery simulation: a multicenter randomized controlled trial.
        Ann Surg. 2014 May 30; ([Epub ahead of print])