Use of Robotic Anastomosis Competency Evaluation (RACE) tool for assessment of surgical competency during urethrovesical anastomosis

Introduction: We sought to evaluate the Robotic Anastomosis Competency Evaluation (RACE) - a validated tool that objectively quantifies surgical skills specifically for urethrovesical anastomosis (UVA) - as a means to track progress of trainees, as well as to determine its predictive value. Methods: UVAs performed by trainees at our institution were evaluated using RACE over a period of two years. Trainees were supervised by an experienced robotic surgeon. Outcomes included trainee-related variables (RACE score, proportion of UVA performed by trainee, and suturing speed), and clinical outcomes (total UVA duration, postoperative urinary continence, and UVA-related complications). Significance was determined using linear regression analysis. Results: A total of 51 UVAs performed by six trainees were evaluated. Trainee RACE scores (19.8 to 22.3; p=0.01) and trainee proportion of UVA (67% to 80%; p=0.003) improved significantly over time. Trainee suture speed was significantly associated with RACE score (mean speed range 0.54-0.74 sutures/minute; p=0.03). Neither urinary continence at six weeks nor at six months was significantly associated with RACE score (p=0.17 and p=0.15, respectively), and only one UVA-related postoperative complication was reported. Conclusions: Trainee RACE scores improved and the proportion of UVA performed by trainees increased over time. RACE can be used as an objective measure of surgical performance during training. Strict mentor supervision allowed safe training without compromising patient outcomes.