You have accessJournal of UrologySurgical Technology & Simulation: Training & Skills Assessment (PD58)1 Sep 2021PD58-03 ASSOCIATIONS IN TECHNICAL SKILL BETWEEN SUCCESSIVE SUTURING SUB-STEPS Daniel I. Sanford, Balint Der, Taseen F. Haque, Runzhuo Ma, Ryan Hakim, Jessica H. Nguyen, Steven Cen, and Andrew J. Hung Daniel I. SanfordDaniel I. Sanford More articles by this author , Balint DerBalint Der More articles by this author , Taseen F. HaqueTaseen F. Haque More articles by this author , Runzhuo MaRunzhuo Ma More articles by this author , Ryan HakimRyan Hakim More articles by this author , Jessica H. NguyenJessica H. Nguyen More articles by this author , Steven CenSteven Cen 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.0000000000002092.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Intra-operative surgeon performance has been associated with post-operative clinical outcomes and complications. Specifically, our prior work found that suturing performance is linked to urinary continence recovery following robot-assisted radical prostatectomy. Herein, we analyze how the successive sub-steps of suturing are interrelated in terms of technical skill. METHODS: 22 surgeons completed a suturing exercise three times on the MimicTM Flex VR simulator. Video recordings were deidentified and assigned technical skill scores by three blinded, independent graders for each sub-step of suturing (needle positioning (1), needle entry angle (2), needle driving (3) and needle withdrawal (4)). Assessments of suturing technical skill were derived from the clinically validated assessment tool Robotic Anastomosis Competency Evaluation (RACE). Hierarchical Poisson regression with Generalized Estimating Equation was used to examine the association between exposure and outcome by adopting the nested data structure of multiple training exercises within each trainee. We have adjusted potential confounders and tested effect modifiers in the Poisson model. RESULTS: Training (n=7, median caseload 0 (IQR 0-8)) and expert (n=15, 300 (165-750)) surgeons completed 428 individual suturing positions. 1,670 technical skill assessments were made. Ideal technical skill scores between needle positioning (1) and needle entry angle (2) (RR 1.12, p=0.05), needle entry angle (2) and needle withdrawal (4) (RR 1.27, p=0.03), and needle driving (3) and needle withdrawal (4) (RR 1.30, p=0.03) were found to be significantly positively associated with each other (Figure 1). With multivariate analysis, taking needle positioning score into account, a positive association for ideal technical skill scores between entry angle (2) and needle withdrawal (4) was found (RR 1.40, p<0.01). CONCLUSIONS: Our study found significant associations in the technical skill required for completing successive sub-steps of the suturing process. Suturing is a chain of events and the success and efficiency of the entire process relies on proper technique in each sequential step. Together with the known association between technical skill and clinical outcomes, training surgeons should focus on not just the overall suturing process, but each sub-step involved. Source of Funding: National Institutes of Biomedical Imaging and Bioengineering of the National Institutes of Health under Award K23EB026493 © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1017-e1017 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel I. Sanford More articles by this author Balint Der More articles by this author Taseen F. Haque More articles by this author Runzhuo Ma More articles by this author Ryan Hakim More articles by this author Jessica H. Nguyen More articles by this author Steven Cen More articles by this author Andrew J. Hung More articles by this author Expand All Advertisement Loading ...
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