Introduction

Surgical trainees are under a multitude of pressures, thus there is requirement for efficient, safe training methods. There is a lack of procedure-specific guidance within minimally invasive surgery. This study sought to:_x000D_ 1. Develop a checklist-based training and assessment tool for RAPN_x000D_ 2. Content validate the assessment tool for use in surgical training.

Methods

This multi-institutional, prospective, longitudinal study occurred from September 2014-June 2015. Healthcare failure mode and effect analysis (HFMEA) was employed in development. The developed RAPN assessment tool was distributed internationally to 13 experts for content validation.

Results

The RAPN training tool contained six phases, 26 processes and 50 sub-processes (Figure 1)._x000D_ RAPN was divided into six phases constituting 28 processes, 64 sub-processes and 84 failure modes. "Preparation of operative field" constituted 9 phases, 15 sub-processes, 17 failure modes. "Exposure of surgical plane" had three processes, six sub-processes, 13 failure modes. "Dissection and control of hilum" included five processes, eight sub-processes, nine related failure modes. "Preparation for hilar clamping and tumour excision" was a five-process stage with seven sub-processes, 10 failure modes. "Hilar clamping, warm ischaemia time and tumour excision" encompassed three processes, 13 sub- processes, 19 failure modes. Lastly, "Finalising and closure" had four processes, 16 sub-processes, 19 failure modes. After excluding detectable failure modes and existing control measures, 45 failure modes had median hazard score 4 and were included in RAPN training tool._x000D_ Content validation occurred across eight institutions worldwide with 13 expert surgeons and their teams of anaesthetists, nurses and technicians. Additionally, the RAPN training tool was circulated among delegates at the European Association of Urology 2015 Annual Congress._x000D_ All participants agreed that the RAPN training tool incorporated crucial elements of the operation.

Conclusions

This study used HFMEA to develop and content validate a RAPN training tool. Hazard analysis and content validation developed a 26- step checklist. Future research will involve validation and application in clinical practice to evaluate the learning curves of RAPN.

Funding

None