PD30-04 SURGICAL GESTURES TO MEASURE SURGICAL DISSECTION PERFORMANCE IN APICAL DISSECTION OF ROBOT-ASSISTED RADICAL PROSTATECTOMY

Abstract

You have accessJournal of UrologyCME1 Apr 2023PD30-04 SURGICAL GESTURES TO MEASURE SURGICAL DISSECTION PERFORMANCE IN APICAL DISSECTION OF ROBOT-ASSISTED RADICAL PROSTATECTOMY Maxwell X. Otiato, Runzhuo Ma, Timothy N. Chu, Elyssa Y. Wong, Christian Wagner, and Andrew J. Hung Maxwell X. OtiatoMaxwell X. Otiato More articles by this author , Runzhuo MaRunzhuo Ma More articles by this author , Timothy N. ChuTimothy N. Chu More articles by this author , Elyssa Y. WongElyssa Y. Wong More articles by this author , Christian WagnerChristian Wagner More articles by this author , and Andrew J. HungAndrew J. Hung More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003316.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Surgical performance impacts patient outcomes, yet ideal performance is challenging to objectively quantify. Previously, we established a surgical gesture classification system that deconstructs robotic tissue dissection into discrete basic surgical maneuvers. Here, we evaluate surgical gestures as a novel assessment method by correlating this metric with surgeon experience and technical skill assessment scores in the apical dissection (AD) of robotic-assisted radical prostatectomy (RARP). METHODS: RARPs from 2016-2018 across two international institutions were included. After standardized training, raters decoded AD surgical videos with surgical gestures. Surgeons were grouped into two experience levels by the median robotic caseload (range 80-5,800 cases; median 475 cases). The less experienced group performed <475 robotic cases and more experienced group performed ≥475 robotic cases. Videos were assessed by a validated assessment tool, Dissection Assessment for Robotic Technique (DART), which contains six domains. A Kruskal-Wallis test was used to compare surgical gesture proportion with DART scores from surgeons of different experience levels. Spearman’s correlation coefficients were used to assess the associations between surgical gesture usage and DART. RESULTS: In total, 78 surgical videos from 20 surgeons were included. More experienced surgeons (n=10) utilized larger proportions of cold cut (50% vs 39%, p=0.008) and smaller proportions of peel/push (12% vs 25%, p=0.02) than less experienced surgeons (n=10). Correlations between the surgical gestures and technical skills assessments ranged from -0.40 to 0.32 using the Spearman’s correlation coefficient (p<0.05, Figure 1b). Surgeons who utilized more retraction gestures had a lower retraction score, efficiency score, and total DART score (all p<0.05). Those who used more discrete gestures and spent more time per gesture had a lower efficiency score (both p<0.01). CONCLUSIONS: Surgeons of different experience levels use different surgical gestures during AD. Significant correlations were demonstrated between surgical gestures and dissection technical skills. Surgical gestures can serve as a novel method to teach and evaluate dissection skill. Source of Funding: Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under Award Number R01CA273031. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e832 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Maxwell X. Otiato More articles by this author Runzhuo Ma More articles by this author Timothy N. Chu More articles by this author Elyssa Y. Wong More articles by this author Christian Wagner More articles by this author Andrew J. Hung More articles by this author Expand All Advertisement PDF downloadLoading ...