MP26-11 PROJECT SURGICAL RADAR: MASTERY REGISTRY OF OBJECTIVE PERFORMANCE INDICATORS DURING A REALISTIC NERVE-SPARING ROBOTIC RADICAL PROSTATECTOMY SIMULATION

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP26-11 PROJECT SURGICAL RADAR: MASTERY REGISTRY OF OBJECTIVE PERFORMANCE INDICATORS DURING A REALISTIC NERVE-SPARING ROBOTIC RADICAL PROSTATECTOMY SIMULATION Nathan Schuler, Lauren Shepard, Andrea Smith, Sue Kulason, Andrew Yee, and Ahmed Ghazi Nathan SchulerNathan Schuler More articles by this author , Lauren ShepardLauren Shepard More articles by this author , Andrea SmithAndrea Smith More articles by this author , Sue KulasonSue Kulason More articles by this author , Andrew YeeAndrew Yee More articles by this author , and Ahmed GhaziAhmed Ghazi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003254.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Erectile dysfunction after nerve-sparing robot-assisted radical prostatectomy (NS-RARP) ranges from 8% to 49% even by high-volume surgeons with no consensus on granular tasks that result in the best potency. Studies found robotic kinematic data to correlate with select RARP clinical outcomes. We analyzed Objective Performance Indicators (OPIs) from a mastery registry of high-volume urologists performing a NS-RARP simulation to identify which metrics can predict operative expertise. METHODS: Thirty urologists (avg. RARP volume=734) performed a NS-RARP on a validated, realistic, hydrogel model with force sensors embedded in the neurovascular bundle (NVB). Robotic kinematic (51 OPIs) and force (number of force peaks, variability, average and total force) data were collected. These OPIs were mapped to broader technical skill categories and used to build logistic regression classifiers that predict the probability of case volume and force data. Data was fit to a Gaussian Mixture model, then separated based on OPIs. Tukey’s HSD test was used to determine significance in inter-group comparisons of overall robotic, RARP volume and force metrics RESULTS: Urologists were clustered into 3 groups based on mean total Overall robotic and RARP volume into 7 Super-Users (SU), 14 High Volume (HV), and 9 Low Volume (LV) surgeons (Figure 1a). OPIs were categorized into 3 broad categories: robotic efficiency, tool motion, and operative fluidity. A significant difference (<0.05) across groups was seen in 31 OPIs (18 across all 3 groups, 10 when comparing SU vs HV and HV vs LV, and 6 when comparing HV vs LV groups). Force metrics showed significant difference comparing SU and HV to LV (Figure 1a). A significant negative correlation was found between force metrics and robotic volume, RARP volume and 13 OPIs (5 robotic efficiency , 4 tool motion, and 4 operative fluidity OPIs) (Figure 1b). CONCLUSIONS: Experienced urologists demonstrated a higher incidence of operative fluidity and tool efficiency OPIs, which are also predictive of less force data applied to the NVB during the simulation. These specific actions specific to super users may improve surgical efficiencies through structured feedback. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e356 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nathan Schuler More articles by this author Lauren Shepard More articles by this author Andrea Smith More articles by this author Sue Kulason More articles by this author Andrew Yee More articles by this author Ahmed Ghazi More articles by this author Expand All Advertisement PDF downloadLoading ...