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Kinematic metrics and surgeon experience in robotic cholecystectomies: a pilot study on breaking down technical performance

  • 2023 SAGES Oral
  • Published:
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Abstract

Background

Recent studies have correlated surgical skill measured by video-based assessment with improved clinical outcomes. Certain automated measures of operative performance in robotic surgery can be gathered beyond video review called objective performance indicators (OPIs). We explore the relationship between OPIs, surgeon experience, and postoperative recovery, hypothesizing that more efficient dissection will be associated with experience.

Methods

Fifty-six robotic cholecystectomies between February 2022 and March 2023 were recorded at a large tertiary referral center. Surgeon experience and clinical outcomes data from the EMR were obtained for all 56 cases with 10 completing the QOL survey. Two steps of robotic cholecystectomies were reviewed: dissection of Calot's triangle (DCT) and dissection of the gallbladder from the liver (DGL). Postoperative recovery was measured using the SF-36 well-being survey. Univariate analysis was conducted using Pearson’s coefficient.

Results

Increased operative experience was associated with more efficient camera and instrument movements. DCT had 7 and DGL had 31 of 41 OPIs that correlated with experience. With respect to DGL, more experienced surgeons had reduced step duration and instrument path length and increased camera and instrument speeds.

Conclusions

Several OPIs correlate with surgical experience and may form the basis of more instructive feedback for trainees and less experienced surgeons in improving intraoperative technique.

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Acknowledgements

None.

Funding

The work of the IPAL is supported by a prior Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Robotic Surgery Grant (2020) and an education grant from the Hugoton Foundation. The work is produced in collaboration with Intuitive Surgical, Inc for which a collaborative agreement is in place for the use of the IDR and compensation for administrative and IRB fees (2022—Ongoing, non-grant support). Ongoing work on the Intuitive Data Recorder is supported by a 2022 Technology Grant from Intuitive Surgical (2022).

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Authors and Affiliations

  1. Intraoperative Performance Analytics Laboratory (IPAL), Department of General Surgery, Northwell Health, Lenox Hill Hospital, New York, NY, USA

    Daniel P. Bitner, Sarah Choksi, Katherine Carsky, Poppy Addison, Robert Andrews, Rebecca Kowalski, Adin Reisner, Alex Farrell, Kavita Jain, Valery Dronsky & Filippo Filicori

  2. Intuitive Surgical, Inc, Sunnyvale, CA, USA

    Anthony Jarc & Andrew Yee

  3. Department of General Surgery, Northwell Health, Lenox Hill Hospital, 186 E 76th Street, First Floor, New York, NY, 10021, USA

    Daniel P. Bitner

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  1. Daniel P. Bitner
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Correspondence to Daniel P. Bitner.

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Disclosures

Dr. Filicori is a consultant for Boston Scientific. Dr. Bitner and Dr. Addison have prior consulting affiliations with Deep Surgery, Inc. Dr. Yee and Dr. Jarc are full time employees of Intuitive Surgical, Inc. Dr. Choksi, Dr. Carsky, Dr. Andrews, Dr. Kowalski, Dr. Reisner, Dr. Farrell, Dr. Jain, and Dr. Dronsky have no conflicts of interest to disclose.

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Bitner, D.P., Choksi, S., Carsky, K. et al. Kinematic metrics and surgeon experience in robotic cholecystectomies: a pilot study on breaking down technical performance. Surg Endosc 38, 913–921 (2024). https://doi.org/10.1007/s00464-023-10481-4

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