Abstract: PD46-11
Sources of Funding: Roswell Park Alliance Foundation

Introduction

Urethrovesical Anastomosis (UVA) is a challenging and critical surgical step performed during Robot-assisted Radical Prostatectomy (RARP). Robotic Anastomosis Competency Evaluation (RACE) is a composite real-time surgical scoring system which measures surgical skills during UVA.

Methods

41 UVAs were performed by 5 surgical trainees during RARP over two academic years at Roswell Park Cancer Institute. The trainees were supervised by experienced robotic surgeons with over 1500 RARP experience. Outcomes included duration of UVA, return of urinary continence, UVA-related complications, and proportions of the UVA performed. Time was measured from the first day of the trainees' clinical fellowship. The trainees began by performing only the anterior portion of the UVA in surgeries before advancing to performing the posterior plate towards the latter half of their fellowship. Effect significance was determined using linear regression analysis.

Results

RACE score improved with time from 20 to 22 (p=0.17) (Figure 1A). Higher RACE scores were associated with fewer number of pads and with improved continence at both 6 weeks (from 4 to 2, p=0.39) and 6 months (from 2 to 1, p=0.75) (Figure 1B). With time, trainees performed a greater percentage of the UVA (Figure 2A). Meanwhile UVA time increased towards the end of the fellowship possibly due to the trainee performing majority portions (Figure 2B). No significant UVA related complications occurred possibly due to strict mentor supervision.

Conclusions

As the fellowship progressed, RACE scores improved and were associated with performing greater proportion of UVA. Higher RACE scores were associated with improved continence. RACE can be used to monitor and mentor the progress of trainees resulting in quality care of patients.

Funding

Roswell Park Alliance Foundation