Development and Validation of Objective Performance Metrics for Robot-Assisted Radical Prostatectomy: A Pilot Study.
Development and Validation of Objective Performance Metrics for Robot-Assisted Radical Prostatectomy: A Pilot Study.
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DOI：
10.1016/j.juro.2017.07.081
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发表时间：
2018-01
期刊：
影响因子：
--
通讯作者：
Gill IS
中科院分区：
文献类型：
--
作者：
Hung AJ;Chen J;Jarc A;Hatcher D;Djaladat H;Gill IS
我们使用一种新的记录器(“dVLogger”)来直接捕捉达芬奇外科系统上的外科医生的操作，来探索和验证客观的外科医生绩效指标。在机器人辅助前列腺癌根治术的预选步骤中，我们提出了客观指标的初始构建和同步验证研究。运动学和事件数据记录在行膀胱松动术、精囊清扫、膀胱输尿管前吻合术和右侧盆腔淋巴清扫术的专家(100例以上)和新手(少于100例)外科医生。使用混合效应统计模型(结构验证)对专家/新手指标进行比较。专家评审员盲目评定使用齿轮的精囊切除和输尿管前膀胱吻合术(机器人技能全球评估)。组内相关性测量评分者之间的变异性。使用Spearman检验(同时验证)将目标指标与相应的齿轮指标相关联。在100例机器人辅助前列腺癌根治术病例中，评估了10位专家(平均810例，范围100~2,000例)和10位新手(平均35例，范围5~80例)的表现。为了进行结构验证，专家们完成手术步骤的速度更快(p<；0.001)，仪器行程距离更短(p<；0.001)，仪器总空闲时间更短(p<；0.001)，摄像机路径长度更短(p<；0.001)，摄像机移动更频繁(p<；0.001)。除膀胱输尿管前吻合术外，专家对所有步骤的显性与非显性器械路径距离的比率较大(p<；0.04)。对于同时验证，3名专家评审员的中位经验为300例(范围为200至500例)。评价者的组内相关系数为0.6-0.7。对于膀胱输尿管前吻合术和精囊剥离，运动学指标与齿轮指标的相关性较低。客观指标显示，在机器人辅助的前列腺癌根治术的预选步骤中，专家更有效率和指导性。客观指标与齿轮的关联有限。这些发现为制定外科医生培训和评估的标准化指标奠定了基础。
We explore and validate objective surgeon performance metrics using a novel recorder (“dVLogger”) to directly capture surgeon manipulations on the da Vinci Surgical System. We present the initial construct and concurrent validation study of objective metrics during preselected steps of robot-assisted radical prostatectomy. Kinematic and events data were recorded for expert (100 or more cases) and novice (less than 100 cases) surgeons performing bladder mobilization, seminal vesicle dissection, anterior vesicourethral anastomosis and right pelvic lymphadenectomy. Expert/novice metrics were compared using mixed effect statistical modeling (construct validation). Expert reviewers blindly rated seminal vesicle dissection and anterior vesicourethral anastomosis using GEARS (Global Evaluative Assessment of Robotic Skills). Intraclass correlation measured inter-rater variability. Objective metrics were correlated to corresponding GEARS metrics using Spearman’s test (concurrent validation). The performance of 10 experts (mean 810 cases, range 100 to 2,000) and 10 novices (mean 35 cases, range 5 to 80) was evaluated in 100 robot-assisted radical prostatectomy cases. For construct validation the experts completed operative steps faster (p <0.001) with less instrument travel distance (p <0.01), less aggregate instrument idle time (p <0.001), shorter camera path length (p <0.001) and more frequent camera movements (p <0.03). Experts had a greater ratio of dominant-to-nondominant instrument path distance for all steps (p <0.04) except anterior vesicourethral anastomosis. For concurrent validation the median experience of 3 expert reviewers was 300 cases (range 200 to 500). Intraclass correlation among reviewers was 0.6–0.7. For anterior vesicourethral anastomosis and seminal vesicle dissection, kinematic metrics had low associations with GEARS metrics. Objective metrics revealed experts to be more efficient and directed during preselected steps of robot-assisted radical prostatectomy. Objective metrics had limited associations to GEARS. These findings lay the foundation for developing standardized metrics for surgeon training and assessment.
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影响因子：
23.4
作者：
Lovegrove, Catherine;Novara, Giacomo;Ahmed, Kamran
通讯作者：
Ahmed, Kamran
DOI：
10.1007/s00464-015-4070-8
发表时间：
2015-11-01
影响因子：
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影响因子：
2.2
作者：
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