University of Southern California, Los Angeles, CA, USA.
Data and Analytics, Intuitive Surgical, Sunnyvale, CA, USA.
Innovations (Phila). 2023 Sep-Oct;18(5):479-488. doi: 10.1177/15569845231204607. Epub 2023 Oct 13.
Existing approaches for assessing surgical performance are subjective and prone to bias. In contrast, utilizing digital kinematic and system data from the surgical robot allows the calculation of objective performance indicators (OPIs) that may differentiate technical skill and competency. This study compared OPIs of trainees and attending surgeons to assess differences during robotic lobectomy (RL).
There were 50 cardiothoracic surgery residents and 7 attending surgeons who performed RL on a left upper lobectomy of an ex vivo perfused model. A novel recorder simultaneously captured video and data from the system and instruments. The lobectomy was annotated into discrete tasks, and OPIs were analyzed for both hands during 6 tasks: exposure of the superior pulmonary vein, upper division of the pulmonary artery and bronchus, and the stapling of these structures.
There were significant differences between attendings and trainees in all tasks. Among 20 OPIs during exposure tasks, significant differences were observed for the left hand in 31 of 60 (52%) of OPIs and for the right hand in 42 of 60 (70%). During stapling tasks, significant differences were observed for the stapling hand in 28 of 60 (47%) of OPIs and for the nonstapling hand in 14 of 60 (25%).
Use of a novel data and video recorder to generate OPIs for both hands revealed significant differences in the operative gestures performed by trainees compared to attendings during RL. This method of assessing performance has potential for establishing objective competency benchmarks and use for tracking progress.
现有的手术绩效评估方法具有主观性，且容易产生偏差。相比之下，利用手术机器人的数字运动学和系统数据，可以计算出可能区分技术技能和能力的客观绩效指标（OPIs）。本研究对比了受训者和主治医生的 OPIs，以评估机器人肺叶切除术（RL）中的差异。
共有 50 名心胸外科住院医师和 7 名主治医生在离体灌注模型上进行了左上肺叶切除术。一种新型记录器同时捕获了视频和系统及器械的数据。将肺叶切除术标记为离散任务，并对 6 个任务中的双手进行了 OPIs 分析：上肺静脉暴露、肺动脉上叶和支气管的上部分离以及这些结构的吻合。
在所有任务中，主治医生和受训者之间均存在显著差异。在暴露任务的 20 个 OPIs 中，左手有 60 个中的 31 个（52%），右手有 60 个中的 42 个（70%）存在显著差异。在吻合任务中，吻合手有 60 个中的 28 个（47%），非吻合手有 60 个中的 14 个（25%）存在显著差异。
使用新型的数据和视频记录器为双手生成 OPIs，结果显示，受训者在 RL 中的手术动作与主治医生相比存在显著差异。这种评估绩效的方法具有建立客观能力基准和跟踪进展的潜力。
