Center for Robotic Simulation and Education, Catherine and Joseph Aresty Department of Urology, University of Southern California Institute of Urology, 1441 Eastlake Avenue, Suite 7416, Los Angeles, CA, 90033, USA.
World J Urol. 2020 Jul;38(7):1615-1621. doi: 10.1007/s00345-019-03010-3. Epub 2019 Nov 14.
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.
本研究旨在探讨受训者参与程度对机器人辅助前列腺根治性切除术（RARP）后手术表现（通过自动绩效指标（APM）测量）和结果的影响。
我们比较了不同住院医师参与程度的病例的 APM（器械跟踪、EndoWrist®关节活动度和系统事件数据）和临床结果。将 12 个标准化 RARP 步骤中的 4 个指定为关键（“核心”）步骤。比较 1：由主治医生完成所有四个核心步骤的病例（A 组）和至少有一名住院医师参与一个核心步骤的病例（B 组）。比较 2 将 A 组分为 C 组和 D 组：由主治医生完成整个手术的病例（C 组）与至少进行一个非核心步骤的住院医师参与的病例（D 组）。 Mann-Whitney U 和卡方检验用于比较。
比较 1 显示 APM 特征存在显著差异，包括摄像机移动时间、第三器械使用、主导器械移动时间、速度、关节活动度，以及非主导器械移动时间和关节活动度（所有 APM 特征均有利于 A 组，p<0.05）。A 组的再入院率（10.9%）与 B 组（0%）存在显著差异（p<0.02），但术后结果无差异。比较 2 显示主导器械关节活动度存在显著差异（p<0.05），但术后结果无差异。
住院医师参与 RARP 是安全的。住院医师参与程度不会显著影响主要临床结果。当住院医师至少进行一个核心步骤时，APM 特征效率较低，但在非核心步骤中则不会。
