International Expert Consensus on Metric-based Characterization of Robot-assisted Partial Nephrectomy

Eur Urol Focus. 2023 Mar;9(2):388-395. doi: 10.1016/j.euf.2022.09.017. Epub 2022 Oct 10.


Background: Robot-assisted partial nephrectomy (RAPN) training usually takes place in vivo, and methods vary across countries/institutions. No common system exists to objectively assess trainee ability to perform RAPN at predetermined performance levels prior to in vivo practice. The identification of objective performance metrics for RAPN training is a crucial starting point to improve training and surgical outcomes.

Objective: We sought to identify objective performance metrics that best characterize a reference approach to RAPN, and obtain face and content validity from procedure experts through a modified Delphi meeting.

Design, setting, and participants: During a series of online meetings, a core metrics team of three RAPN experts and a senior behavioral scientist performed a detailed task deconstruction of a transperitoneal left-sided RAPN procedure.

Outcome measurements and statistical analysis: Based on published guidelines, manufacturers' instructions, and unedited videos of RAPN, the team identified performance metrics that constitute an optimal approach for training purposes. The metrics were then subjected to an in-person modified international Delphi panel meeting with 19 expert surgeons.

Results and limitations: Eleven procedure phases, with 64 procedure steps, 43 errors, and 39 critical errors, were identified. After the modified Delphi process, the international expert panel added 13 metrics (two steps), six were deleted, and three were modified; 100% panel consensus on the resulting metrics was obtained. Limitations are that the metrics are applicable only to left-sided RAPN cases and some might have been excluded.

Conclusions: Performance metrics that accurately characterize RAPN procedure were developed by a core group of experts. The metrics were then presented to and endorsed by an international panel of very experienced peers. Reliable and valid metrics underpin effective, quality-assured, structured surgical training for RAPN.

Patient summary: We organize a meeting among robot-assisted partial nephrectomy (RAPN) experts to identify and reach consensus on objective performance metrics for RAPN training. The metrics are a crucial starting point to improve and quality assure surgical training and patients' clinical outcomes.

Keywords: Construct validation; Proficiency-based metrics; Proficiency-based training; Robot-assisted partial nephrectomy; Surgical training.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Consensus
  • Humans
  • Laparoscopy*
  • Nephrectomy / methods
  • Robotic Surgical Procedures* / methods
  • Robotics*