Orsi Academy, Melle, Belgium.
Department of Urology, Onze Lieve Vrouw Hospital (OLV), Aalst, Belgium.
BJU Int. 2021 Jul;128(1):103-111. doi: 10.1111/bju.15311. Epub 2020 Dec 20.
OBJECTIVE: To develop and seek consensus from procedure experts on the metrics that best characterise a reference robot-assisted radical prostatectomy (RARP) and determine if the metrics distinguished between the objectively assessed RARP performance of experienced and novice urologists, as identifying objective performance metrics for surgical training in robotic surgery is imperative for patient safety. MATERIALS AND METHODS: In Study 1, the metrics, i.e. 12 phases of the procedure, 81 steps, 245 errors and 110 critical errors for a reference RARP were developed and then presented to an international Delphi panel of 19 experienced urologists. In Study 2, 12 very experienced surgeons (VES) who had performed >500 RARPs and 12 novice urology surgeons performed a RARP, which was video recorded and assessed by two experienced urologists blinded as to subject and group. Percentage agreement between experienced urologists for the Delphi meeting and Mann-Whitney U- and Kruskal-Wallis tests were used for construct validation of the newly identified RARP metrics. RESULTS: At the Delphi panel, consensus was reached on the appropriateness of the metrics for a reference RARP. In Study 2, the results showed that the VES performed ~4% more procedure steps and made 72% fewer procedure errors than the novices (P = 0.027). Phases VIIa and VIIb (i.e. neurovascular bundle dissection) best discriminated between the VES and novices. LIMITATIONS: VES whose performance was in the bottom half of their group demonstrated considerable error variability and made five-times as many errors as the other half of the group (P = 0.006). CONCLUSIONS: The international Delphi panel reached high-level consensus on the RARP metrics that reliably distinguished between the objectively scored procedure performance of VES and novices. Reliable and valid performance metrics of RARP are imperative for effective and quality assured surgical training.
目的:制定并寻求程序专家对最佳描述参考机器人辅助根治性前列腺切除术(RARP)的指标的共识,并确定这些指标是否能区分经验丰富和新手泌尿科医生的客观评估 RARP 表现,因为确定机器人手术中手术培训的客观表现指标对患者安全至关重要。
材料与方法:在研究 1 中,制定了参考 RARP 的 12 个阶段、81 个步骤、245 个错误和 110 个关键错误等指标,然后将其呈现给一个由 19 名经验丰富的泌尿科医生组成的国际 Delphi 小组。在研究 2 中,12 名经验丰富的外科医生(VES)完成了>500 例 RARP,12 名新手泌尿科医生进行了 RARP,由两名经验丰富的泌尿科医生进行视频记录和评估,他们对受试者和小组均不知情。经验丰富的泌尿科医生之间的 Delphi 会议的百分比一致性以及 Mann-Whitney U-和 Kruskal-Wallis 检验用于新确定的 RARP 指标的结构验证。
结果:在 Delphi 小组中,就参考 RARP 指标的适当性达成了共识。在研究 2 中,结果表明,VES 完成的手术步骤比新手多约 4%,且手术错误少 72%(P=0.027)。第七 a 期和第七 b 期(即神经血管束解剖)是区分 VES 和新手的最佳指标。
局限性:在他们组中表现处于后半部分的 VES 表现出相当大的错误变异性,并且犯的错误是该组前半部分的五倍(P=0.006)。
结论:国际 Delphi 小组就 RARP 指标达成了高度共识,这些指标可靠地区分了 VES 和新手的客观评分手术表现。RARP 的可靠和有效的表现指标对有效的、有质量保证的手术培训至关重要。
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