Abstract: PD41-12
Sources of Funding: None

Introduction

More attention has been directed to surgeon performance and surgical outcomes. A novel recording solution (&[Prime]dVLogger&[Prime]) for direct capture of surgeon manipulations on the da Vinci surgeon console has been deployed to explore and validate automated surgeon performance metrics. Herein, we present an initial construct validation (expert vs novice) of metrics during select steps of the robotic radical prostatectomy (RRP)._x000D_

Methods

We recorded performance data from da Vinci Si systems for training (<200 console cases) and expert (≥200 cases) surgeons performing 4 RRP steps: bladder mobilization (BM), seminal vesicles dissection (SVD), anterior vesicourethral anastomosis (AA) and right pelvic lymph nodes dissection (RLD). The performance metrics, including instrument movements, hand controller movements, and system events, were computed and compared between expert/training groups using the Kruskal-Wallis test._x000D_

Results

We evaluated 40 RRP cases. Eight experts (median 450 (200-2000) console cases experience) and 8 novices (median 50 (30-150) cases) participated. For all 4 steps, experts outperformed trainees in total moving time of all instruments (28 vs 49 min, 16 vs 28 min, 15 vs 27 min, 25 vs 52 min respectfully, p<0.01), and total distance traveled by all instruments (33.2 vs 52.6 m, 15.7 vs 25.4 m, 14 vs 20.1 m, 30 vs 59.4 m respectfully, p<0.01). For BM, SVD, AA, experts moved instrument controlled by their dominant hand faster than trainees (2.8 vs 2.3 cm/s, 2.2 vs 1.9 cm/s, 1.8 vs 1.4 cm/s respectfully, p<0.02). Experts applied energy more often than novices during BM, SVD, and RLD (9 vs 6.6 times/min, 8.4 vs 5.4 times/min, 7.2 vs 3.6 times/min respectfully, p<0.01). During AA and RLD, experts adjusted camera position more often than trainees (6 vs 4 times/min, 6.6 vs 5.4 times/min, p<0.05). During BM, experts adjusted hand controller position (i.e. master clutch) more often (2.4 vs 1.8 times/min, p=0.007). Experts were more efficient during the RLD than trainees (1.75 vs 3.3 min/node, p=0.001)._x000D_

Conclusions

Experts were more efficient and directed in their movement. Further correlation of metrics to clinical outcomes would further validate their clinical significance. This data can also help establish standardized metrics for surgeon assessment, credentialing, and workflow efficiency._x000D_

Funding

None