Login to Access Video or Poster Abstract: MP51-15
Sources of Funding: None

Introduction

The few studies that question the role of individual surgeon&[prime]s technical skill in influencing patient outcomes and safety have produced compelling results. To date, this linkage has not been published in urology. We designed a study to understand how surgeon skill and error rating contribute to functional outcomes in robotic-assisted radical prostatectomy (RARP).

Methods

We conducted a case-matched analysis of 28 prospectively collected RARP endoscopic videos performed by a single surgeon, between 2008 and 2015. Research Ethics Board approval was granted. Patient information was retrieved from an institutionally maintained database. The primary outcome parameter was continence status at 3 months post-operatively, defined as patient use of more than a single precautionary pad. A blinded observer with expertise in intraoperative video analysis evaluated clinically relevant steps of RARP using the Global Evaluative Assessment of Robotic Skill (GEARS), Robotic Anastomosis Competency Evaluation (RACE) and the Generic Error Rating Tool (GERT). Mann Whitney U tests explored differences in predictor variables between cases and controls (two-tailed, p≤0.05).

Results

14 patients deemed to be incontinent at 3 months were matched for age, pre-operative International Prostate Symptoms Score (IPSS), use of posterior/anterior hitch, and prostate weight. Matching also accounted for position of the case on the surgeon&[prime]s learning curve. Statistically significant differences were detected on nonparametric testing in RACE (p=0.03) score and GEARS urethrovesical anastomosis score (p=0.02) between case and control groups. There were a greater number of errors committed during bladder neck dissection in the incontinent patient cohort (p=0.01).

Conclusions

Our study is the first that suggests a link between surgeon technical performance and continence outcomes in RARP. While this single surgeon, patient-matched case-control design limits confounding, multi-institutional prospective studies studying multiple surgeons of different abilities forms the basis of future research in this area. The implication of our findings are potentially far reaching, and moving forward, stakeholders in education and accreditation of RARP should incorporate both surgeon technical skill and error rating into judgments of surgical quality.

Funding

None