Department of Surgery, Emory University School of Medicine, Atlanta, GA.
Winship Cancer Institute, Emory University, Atlanta, GA.
Surgery. 2024 Dec;176(6):1591-1597. doi: 10.1016/j.surg.2024.08.015. Epub 2024 Sep 20.
Robotic surgery is perceived to be more complex in obese patients. Objective performance indicators, machine learning-enabled metrics, can provide objective data regarding surgeon movements and robotic arm kinematics. In this feasibility study, we identified differences in objective performance indicators during robotic proctectomy in obese and nonobese patients.
Endoscopic videos were annotated to delineate individual surgical steps across 39 robotic proctectomies (1880 total steps). Thirteen patients were obese and 26 were nonobese. Objective performance indicators during the following steps were analyzed: splenic flexure mobilization, left colon mobilization, pelvic dissection, and rectal transection.
The following differences were noted during robotic proctectomy in obese patients: during splenic flexure mobilization, more arm swaps, longer camera path length and velocity; during left colon mobilization, longer step time, more arm swaps, higher camera-related metrics (movement, path length, velocity, acceleration, and jerk), greater dominant arm path length, moving time, and wrist articulation; during anterior pelvic dissection, longer energy activation time, camera path length, and moving time; during posterior pelvic dissection, lower nondominant arm velocity, jerk, and acceleration; during left pelvic dissection, longer energy activation time; during right pelvic dissection, greater camera-related metrics (movement, path length, moving time, and velocity); and during rectal transection, longer step time, more arm swaps, master clutch use and camera movements, greater dominant wrist articulation, and longer dominant arm path length.
We report step-specific objective performance indicators that differ during robotic proctectomy for obese and nonobese patients. This is the first study to use objective performance indicators to correlate a patient attribute with surgeon movements and robotic arm kinematics during robotic colorectal surgery.
机器人手术在肥胖患者中被认为更为复杂。客观绩效指标，即机器学习支持的指标，可以提供有关外科医生运动和机器人手臂运动学的客观数据。在这项可行性研究中，我们确定了肥胖和非肥胖患者行机器人直肠切除术时客观绩效指标的差异。
通过对 39 例机器人直肠切除术（共 1880 个手术步骤）的内镜视频进行注释，确定了每个手术步骤的个体手术步骤。其中 13 例患者肥胖，26 例非肥胖。分析了以下步骤中的客观绩效指标：脾曲游离、左半结肠游离、盆腔解剖和直肠横断。
在肥胖患者的机器人直肠切除术中，我们注意到以下差异：在脾曲游离时，手臂交换次数更多，摄像器的路径长度和速度更长；在左半结肠游离时，步骤时间更长，手臂交换次数更多，摄像器相关指标（运动、路径长度、速度、加速度和急动度）更高，主导臂路径长度、移动时间和手腕关节活动度更大；在前盆腔解剖时，能量激活时间、摄像器路径长度和移动时间更长；在后盆腔解剖时，非主导臂速度、急动度和加速度更低；在左盆腔解剖时，能量激活时间更长；在右盆腔解剖时，摄像器相关指标（运动、路径长度、移动时间和速度）更大；在直肠横断时，步骤时间更长，手臂交换次数更多，主离合器使用和摄像器移动次数更多，主导手腕关节活动度更大，主导臂路径长度更长。
我们报告了肥胖和非肥胖患者行机器人直肠切除术时存在差异的特定步骤的客观绩效指标。这是第一项使用客观绩效指标将患者特征与机器人结直肠手术期间外科医生运动和机器人手臂运动学相关联的研究。
