Development and Validation of an Objective Scoring Tool for Robot-Assisted Partial Nephrectomy: Scoring for Partial Nephrectomy

Umar Iqbal, Zhe Jing, Youssef Ahmed, Ahmed S. Elsayed, Craig Rogers, Ronald Boris, James Porter, Mohammad Allaf, Ketan Badani, Michael Stifelman, Jihad Kaouk, Tomoaki Terakawa, Nobuyuki Hinata, Ahmed A. Aboumohamed, Eric Kauffman, Qiang Li, Ronney Abaza, Khurshid A. Guru, Ahmed A. Hussein, Daniel Eun

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objective: To develop a structured and objective scoring tool for assessment of robot-assisted partial nephrectomy (RAPN): Scoring for Partial Nephrectomy (SPaN). Materials and Methods: Content development: RAPN was deconstructed into 6 domains by a multi-institutional panel of 10 expert robotic surgeons. Performance on each domain was represented on a Likert scale of 1 to 5, with specific descriptions of anchors 1, 3, and 5. Content validation: The Delphi methodology was utilized to achieve consensus about the description of each anchor for each domain in terms of appropriateness of the skill assessed, objectiveness, clarity, and unambiguous wording. The content validity index (CVI) of ≥0.75 was set as cutoff for consensus. Reliability: 15 de-identified videos of RAPN were utilized to determine the inter-rater reliability using linearly weighted percent agreement, and Construct validation of SPaN was described in terms of median scores and odds ratios. Results: The expert panel reached consensus (CVI ≥0.75) after 2 rounds. Consensus was achieved for 36 (67%) statements in the first round and 18 (33%) after the second round. The final six-domain SPaN included Exposure of the kidney; Identification and dissection of the ureter and gonadal vessels; Dissection of the hilum; Tumor localization and exposure; Clamping and tumor resection; and Renorrhaphy. The linearly weighted percent agreement was >0.75 for all domains. There was no difference between median scores for any domain between attendings and trainees. Conclusion: Despite the lack of significant construct validity, SPaN is a structured, reliable, and procedure-specific tool that can objectively assesses technical proficiency for RAPN.

Original languageEnglish (US)
Pages (from-to)647-653
Number of pages7
JournalJournal of Endourology
Issue number5
StatePublished - May 1 2022
Externally publishedYes


  • assessment
  • partial nephrectomy
  • robot-assisted
  • scoring tool
  • surgical training

ASJC Scopus subject areas

  • Urology


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