Good Samaritan Medical Center, Brockton, MA, USA.
Applied Research, Intuitive Surgical Inc., Peachtree City, GA, USA.
Surg Endosc. 2023 Nov;37(11):8540-8551. doi: 10.1007/s00464-023-10432-z. Epub 2023 Oct 3.
The increased digitization in robotic surgical procedures today enables surgeons to quantify their movements through data captured directly from the robotic system. These calculations, called objective performance indicators (OPIs), offer unprecedented detail into surgical performance. In this study, we link case- and surgical step-specific OPIs to case complexity, surgical experience and console utilization, and post-operative clinical complications across 87 robotic cholecystectomy (RC) cases.
Videos of RCs performed by a principal surgeon with and without fellows were segmented into eight surgical steps and linked to patients' clinical data. Data for OPI calculations were extracted from an Intuitive Data Recorder and the da Vinci ® robotic system. RC cases were each assigned a Nassar and Parkland Grading score and categorized as standard or complex. OPIs were compared across complexity groups, console attributions, and post-surgical complication severities to determine objective relationships across variables.
Across cases, differences in camera control and head positioning metrics of the principal surgeon were observed when comparing standard and complex cases. Further, OPI differences across the principal surgeon and the fellow(s) were observed in standard cases and include differences in arm swapping, camera control, and clutching behaviors. Monopolar coagulation energy usage differences were also observed. Select surgical step duration differences were observed across complexities and console attributions, and additional surgical task analyses determine the adhesion removal and liver bed hemostasis steps to be the most impactful steps for case complexity and post-surgical complications, respectively.
This is the first study to establish the association between OPIs, case complexities, and clinical complications in RC. We identified OPI differences in intra-operative behaviors and post-surgical complications dependent on surgeon expertise and case complexity, opening the door for more standardized assessments of teaching cases, surgical behaviors and case complexities.
当今，机器人手术过程中的数字化程度不断提高，使外科医生能够通过直接从机器人系统捕获的数据来量化他们的动作。这些计算结果被称为客观绩效指标 (OPI)，为手术绩效提供了前所未有的详细信息。在这项研究中，我们将特定病例和手术步骤的 OPI 与病例复杂性、手术经验和控制台使用情况以及 87 例机器人胆囊切除术 (RC) 术后临床并发症联系起来。
将一位主刀医生进行的 RC 手术视频按 8 个手术步骤进行分割，并与患者的临床数据相关联。用于 OPI 计算的数据是从达芬奇 ® 机器人系统的直观数据记录器中提取的。RC 病例均被分配 Nassar 和 Parkland 分级评分，并分为标准或复杂病例。对复杂性组、控制台归因和术后并发症严重程度的 OPI 进行比较，以确定变量之间的客观关系。
在所有病例中，当比较标准和复杂病例时，主刀医生的摄像控制和头部定位指标存在差异。此外，在标准病例中，主刀医生和（或）助手的 OPI 存在差异，包括手臂交换、摄像控制和握持行为的差异。还观察到单极电凝能量使用的差异。观察到各复杂性和控制台归因之间的某些手术步骤持续时间的差异，并且进一步的手术任务分析确定了去除粘连和肝床止血步骤分别是影响病例复杂性和术后并发症的最关键步骤。
这是第一项在 RC 中建立 OPI、病例复杂性和临床并发症之间关联的研究。我们确定了手术行为和术后并发症与外科医生专业知识和病例复杂性相关的 OPI 差异，为更标准化地评估教学病例、手术行为和病例复杂性开辟了道路。
