Nawalaniec James, Shields Mallory, Auchincloss Hugh, Jeffrey Yang Chi-Fu, Schumacher Lana
Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass.
Intuitive Surgical, Inc, Sunnyvale, Calif.
JTCVS Open. 2025 Feb 26;26:299-305. doi: 10.1016/j.xjon.2025.02.011. eCollection 2025 Aug.
Current evaluation of robotic surgeon proficiency relies on subjective assessment. The robotic platform collects highly granular kinematic data on surgeon activity, known as objective performance indicators (OPIs). We sought to compare surgeon proficiency during lobectomies across training levels using OPIs.
Under institutional review board approval, we analyzed robotic lobectomies between November 2022 and February 2023 performed by 2 expert robotic thoracic surgeons (>200 robotic lobectomies) and their trainees using OPI recorders. A professional annotator segmented each case into standardized steps, and an operating surgeon (trainee or attending) was assigned to that step on the basis of the active console. Kinematic data were compared between surgeon groups. A subgroup analysis was performed dividing the trainee group into junior (postgraduate year 3-5) and senior residents (postgraduate year 6-8).
In total, 26 lobectomies with 410 discrete tasks performed by attending surgeons and 344 by trainees were included. In the attending group, there were significantly greater rates of camera clutching per minute compared with trainees (2.94 vs 2.52, respectively; = .0005). The ratio of right to left hand use was significantly greater in the trainee group (1.52 vs 1.48, = .0047). Average instrument speed was faster in the attending group (1.24 vs 1.13 meters/min, = .0061). Differences in clutching and speed, but not hand dexterity, remained significant when the trainee group was subdivided into beginner and intermediate robotic surgeons.
There are significant differences in objective performance indicators between expert and beginner robotic surgeons. These results demonstrate the feasibility of incorporating kinematic performance data into thoracic surgeon assessment in a clinical setting.
目前对机器人手术医生熟练程度的评估依赖主观评价。机器人平台收集有关手术医生活动的高度细化的运动学数据，即客观性能指标（OPIs）。我们试图使用OPIs比较不同培训水平的医生在肺叶切除术中的熟练程度。
在机构审查委员会批准下，我们分析了2022年11月至2023年2月期间由2名经验丰富的机器人胸外科医生（>200例机器人肺叶切除术）及其受训人员使用OPI记录器进行的机器人肺叶切除术。一名专业注释员将每个病例分割为标准化步骤，并根据活动控制台将一名手术医生（受训人员或主治医生）分配到该步骤。比较了不同医生组之间的运动学数据。进行了亚组分析，将受训人员组分为初级（研究生3至5年级）和高级住院医师（研究生6至8年级）。
总共纳入了26例肺叶切除术，其中主治医生执行了410项离散任务，受训人员执行了34项。在主治医生组中，每分钟抓握摄像头的比率显著高于受训人员（分别为2.94次和2.52次；P = 0.0005）。受训人员组右手与左手使用比例显著更高（1.52比1.48，P = 0.0047）。主治医生组的平均器械速度更快（1.24比1.13米/分钟，P = 0.0061）。当将受训人员组细分为初级和中级机器人手术医生时，抓握和速度的差异仍然显著，但手部灵活性差异不显著。
专家级和初级机器人手术医生在客观性能指标上存在显著差异。这些结果证明了在临床环境中将运动学性能数据纳入胸外科医生评估的可行性。
