Tailored Feedback Based on Clinically Relevant Performance Metrics Expedites the Acquisition of Robotic Suturing Skills-An Unblinded Pilot Randomized Controlled Trial
Tailored Feedback Based on Clinically Relevant Performance Metrics Expedites the Acquisition of Robotic Suturing Skills-An Unblinded Pilot Randomized Controlled Trial
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DOI：
10.1097/ju.0000000000002691
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发表时间：
2022-08-01
影响因子：
6.6
通讯作者：
Hung, Andrew J.
中科院分区：
文献类型：
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作者：
Ma, Runzhuo;Lee, Ryan S.;Hung, Andrew J.
目的：之前，我们确定了 8 个客观缝合性能指标，可以高度预测机器人辅助根治性前列腺切除术后尿失禁的恢复。在这里，我们的目的是测试根据这些临床相关指标提供定制反馈的可行性，并探讨对获得机器人缝合技能的影响。材料和方法：招募训练外科医生并随机分配到反馈组或对照组。两组均完成基线、中期和最终干实验室膀胱尿道吻合术 (VUA)，并各接受 4 次干预训练，其中包括 3 次缝合练习。每次练习期间记录了八个性能指标：4 个自动化性能指标（源自达芬奇 (R) 机器人系统的运动学和系统事件数据）代表效率和控制台操作能力，以及 4 个缝合技术技能得分。每次会议后，反馈小组都会收到基于这些指标的定制反馈（可视化图表+口头说明+视频示例）。使用广义线性混合模型来比较从基线到中期和最终 VUA 的指标改进 (Delta)。 结果：23 名参与者被随机分配到反馈组 (11) 或对照组 (12)。各组之间的人口统计数据和基线 VUA 指标具有可比性。反馈组在期中总缝合分数（平均 Delta 反馈组 4.5 vs Delta 对照组 1.1）和最终 VUA（Delta 反馈组 5.3 vs Delta 对照组 4.9）方面显示出比对照组更大的改善。反馈小组还在中期和最终 VUA 所包含的大多数指标上显示出更大的改进。结论：基于具体的、临床相关的绩效指标的定制反馈是可行的，并且可以加快机器人缝合技能的掌握。
Purpose: Previously, we identified 8 objective suturing performance metrics highly predictive of urinary continence recovery after robotic-assisted radical prostatectomy. Here, we aimed to test the feasibility of providing tailored feedback based upon these clinically relevant metrics and explore the impact on the acquisition of robotic suturing skills.Materials and Methods: Training surgeons were recruited and randomized to a feedback group or a control group. Both groups completed a baseline, midterm and final dry laboratory vesicourethral anastomosis (VUA) and underwent 4 intervening training sessions each, consisting of 3 suturing exercises. Eight performance metrics were recorded during each exercise: 4 automated performance metrics (derived from kinematic and system events data of the da Vinci (R) Robotic System) representing efficiency and console manipulation competency, and 4 suturing technical skill scores. The feedback group received tailored feedback (a visual diagram+verbal instructions+video examples) based on these metrics after each session. Generalized linear mixed model was used to compare metric improvement (Delta) from baseline to the midterm and final VUA.Results: Twenty-three participants were randomized to the feedback group (11) or the control group (12). Demographic data and baseline VUA metrics were comparable between groups. The feedback group showed greater improvement than the control group in aggregate suturing scores at midterm (mean Delta feedback group 4.5 vs Delta control group 1.1) and final VUA (Delta feedback group 5.3 vs Delta control group 4.9). The feedback group also showed greater improvement in the majority of the included metrics at midterm and final VUA.Conclusions: Tailored feedback based on specific, clinically relevant performance metrics is feasible and may expedite the acquisition of robotic suturing skills.