Comparison of clinical outcomes and automated performance metrics in robot-assisted radical prostatectomy with and without trainee involvement
In this study, we investigate the effect of trainee involvement on surgical performance, as measured by automated performance metrics (APMs), and outcomes after robot-assisted radical prostatectomy (RARP).
We compared APMs (instrument tracking, EndoWrist® articulation, and system events data) and clinical outcomes for cases with varying resident involvement. Four of 12 standardized RARP steps were designated critical (“cardinal”) steps. Comparison 1: cases where the attending surgeon performed all four cardinal steps (Group A) and cases where a trainee was involved in at least one cardinal step (Group B). Comparison 2, where Group A is split into Groups C and D: cases where attending performs the whole case (Group C) vs. cases where a trainee performed at least one non-cardinal step (Group D). Mann–Whitney U and Chi-squared tests were used for comparisons.
Comparison 1 showed significant differences in APM profiles including camera movement time, third instrument usage, dominant instrument moving time, velocity, articulation, as well as non-dominant instrument moving time and articulation (all favoring Group A p < 0.05). There was a significant difference in re-admission rates (10.9% in Group A vs 0% in Group B, p < 0.02), but not for post-operative outcomes. Comparison 2 demonstrated a significant difference in dominant instrument articulation (p < 0.05) but not in post-operative outcomes.
Trainee involvement in RARP is safe. The degree of trainee involvement does not significantly affect major clinical outcomes. APM profiles are less efficient when trainees perform at least one cardinal step but not during non-cardinal steps.
KeywordsAutomatic performance metrics Resident surgical training Surgical education Robotic surgical procedures Prostatectomy
Research reported in this publication was supported in part by the National Institute of Biomedical Imaging And Bioengineering of the National Institutes of Health under Award Number K23EB026493 and an Intuitive Surgical Clinical Research Grant. Anthony Jarc and Liheng Guo (Intuitive Surgical, Inc.) assisted with automated performance metric processing.
AC: Data analysis, manuscript writing/editing. S Ghodoussipour: Manuscript writing/editing. MBT: Data collection/management, manuscript writing/editing. JHN: Data collection/management, manuscript writing/editing. JC: Data collection/management, data analysis, manuscript writing/editing. RM: Data analysis, manuscript writing/editing. AJH: Project development, manuscript writing/editing.
Compliance with ethical standards
Conflict of interest
The study was supported in part by an Intuitive Surgical, Inc. clinical grant. Intuitive Surgical, Inc. provided the systems events data recorder.
Human and animals rights
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.
Informed consent was obtained from all individual participants included in the study.
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