Center for Robotic Simulation and Education, Catherine and Joseph Aresty Department of Urology, University of Southern California Institute of Urology, University of Southern California, Los Angeles, California; Medical Research, Intuitive Surgical, Inc. (AJ, LG), Norcross, Georgia.
Center for Robotic Simulation and Education, Catherine and Joseph Aresty Department of Urology, University of Southern California Institute of Urology, University of Southern California, Los Angeles, California; Medical Research, Intuitive Surgical, Inc. (AJ, LG), Norcross, Georgia.
J Urol. 2018 Oct;200(4):895-902. doi: 10.1016/j.juro.2018.05.080. Epub 2018 May 22.
We sought to develop and validate automated performance metrics to measure surgeon performance of vesicourethral anastomosis during robotic assisted radical prostatectomy. Furthermore, we sought to methodically develop a standardized training tutorial for robotic vesicourethral anastomosis.
We captured automated performance metrics for motion tracking and system events data, and synchronized surgical video during robotic assisted radical prostatectomy. Nonautomated performance metrics were manually annotated by video review. Automated and nonautomated performance metrics were compared between experts with 100 or more console cases and novices with fewer than 100 cases. Needle driving gestures were classified and compared. We then applied task deconstruction, cognitive task analysis and Delphi methodology to develop a standardized robotic vesicourethral anastomosis tutorial.
We analyzed 70 vesicourethral anastomoses with a total of 1,745 stitches. For automated performance metrics experts outperformed novices in completion time (p <0.01), EndoWrist® articulation (p <0.03), instrument movement efficiency (p <0.02) and camera manipulation (p <0.01). For nonautomated performance metrics experts had more optimal needle to needle driver positioning, fewer needle driving attempts, a more optimal needle entry angle and less tissue trauma (each p <0.01). We identified 14 common robotic needle driving gestures. Random gestures were associated with lower efficiency (p <0.01), more attempts (p <0.04) and more trauma (p <0.01). The finalized tutorial contained 66 statements and figures. Consensus among 8 expert surgeons was achieved after 2 rounds, including among 58 (88%) after round 1 and 8 (12%) after round 2.
Automated performance metrics can distinguish surgeon expertise during vesicourethral anastomosis. The expert vesicourethral anastomosis technique was associated with more efficient movement and less tissue trauma. Standardizing robotic vesicourethral anastomosis and using a methodically developed tutorial may help improve robotic surgical training.
我们旨在开发和验证自动化绩效指标，以衡量机器人辅助根治性前列腺切除术中尿道吻合术的外科医生表现。此外，我们还旨在系统地开发机器人尿道吻合术的标准化培训教程。
我们捕获了运动跟踪和系统事件数据的自动化绩效指标，并在机器人辅助根治性前列腺切除术中同步手术视频。非自动化绩效指标由视频审查手动注释。将专家（100 例以上控制台病例）和新手（少于 100 例病例）的自动和非自动绩效指标进行比较。对针驱动手势进行分类和比较。然后，我们应用任务解构、认知任务分析和 Delphi 方法来开发标准化的机器人尿道吻合术教程。
我们分析了 70 例尿道吻合术，总共有 1745 针。对于自动化绩效指标，专家在完成时间（p <0.01）、EndoWrist®关节（p <0.03）、器械运动效率（p <0.02）和相机操作（p <0.01）方面优于新手。对于非自动化绩效指标，专家具有更优的针与针驱动器定位、更少的针驱动尝试、更优的针入口角度和更少的组织创伤（均 p <0.01）。我们确定了 14 种常见的机器人针驱动手势。随机手势与效率较低（p <0.01）、尝试次数较多（p <0.04）和创伤较多（p <0.01）相关。最终的教程包含 66 个陈述和数字。在两轮之后，8 位专家外科医生达成了共识，包括第一轮后的 58 位（88%）和第二轮后的 8 位（12%）。
自动化绩效指标可以区分尿道吻合术中外科医生的专业水平。专家的尿道吻合技术与更高效的运动和更少的组织创伤相关。标准化机器人尿道吻合术并使用系统开发的教程可能有助于改善机器人手术培训。
