Development, validation and clinical application of Pelvic Lymphadenectomy Assessment and Completion Evaluation: intraoperative assessment of lymph node dissection after robot‐assisted radical cystectomy for bladder cancer

Objectives To develop a scoring tool, Pelvic Lymphadenectomy Appropriateness and Completion Evaluation ( PLACE ), to assess the intraoperative completeness and appropriateness of pelvic lymph node dissection ( PLND ) following robot‐assisted radical cystectomy ( RARC ). Patients, Subjects and Methods A panel of 11 open and robotic surgeons developed the content and structure of PLACE . The PLND template was divided into three zones. In all, 21 de‐identified videos of bilateral robot‐assisted PLND s were assessed by the 11 experts using PLACE to determine inter‐rater reliability. Lymph node ( LN ) clearance was defined as the proportion of cleared LN s from all PLACE zones. We investigated the correlation between LN clearance and LN count. Then, we compared the LN count of 18 prospective PLND s using PLACE with our retrospective series performed using the extended template (No PLACE ). Results A significant reliability was achieved for all PLACE zones among the 11 raters for the 21 bilateral PLND videos. The median (interquartile range) for LN clearance was 468 (431–545). There was a significant positive correlation between LN clearance and LN count ( R 2 = 0.70, P < 0.01). The PLACE group yielded similar LN counts when compared to the No PLACE group. Conclusions Pelvic Lymphadenectomy Appropriateness and Completion Evaluation is a structured intraoperative scoring system that can be used intraoperatively to measure and quantify PLND for quality control and to facilitate training during RARC .