Comparison of clinical outcomes and automated performance metrics in robot-assisted radical prostatectomy with and without trainee involvement
Comparison of clinical outcomes and automated performance metrics in robot-assisted radical prostatectomy with and without trainee involvement
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DOI：
10.1007/s00345-019-03010-3
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发表时间：
2020-07-01
影响因子：
3.4
通讯作者：
Hung, Andrew J.
中科院分区：
文献类型：
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作者：
Chen, Andrew;Ghodoussipour, Saum;Hung, Andrew J.
目的在这项研究中，我们调查了受训者参与对手术性能的影响，通过自动性能指标（APM）和机器人辅助根治性直肠癌切除术（RARP）后的结果进行测量。方法我们比较了不同住院医师参与病例的APM（器械跟踪、EndoWrist（R）关节和系统事件数据）和临床结局。12个标准化RARP步骤中的4个被指定为关键（“基本”）步骤。比较1：其中主治外科医生执行所有四个基本步骤的病例（A组）和受训者参与至少一个基本步骤的病例（B组）。比较2，其中A组分为C组和D组：主治医师执行整个病例的情况（C组）与受训者执行至少一个非主要步骤的情况（D组）。采用Mann-Whitney检验和卡方检验进行比较。结果比较1组在相机移动时间、第三器械使用、优势器械移动时间、速度、清晰度以及非优势器械移动时间和清晰度方面均优于A组（p < 0.05）。两组的再入院率有显著差异（A组10.9% vs B组0%，p < 0.02），但术后结局无显著差异。比较2显示了主导器械关节的显著差异（p < 0.05），但术后结局无显著差异。结论受训者参与RARP是安全的。受训者参与程度对主要临床结果无显著影响。当受训者执行至少一个基本步骤时，APM配置文件的效率较低，但在非基本步骤期间则不然。
Purpose In this study, we investigate the effect of trainee involvement on surgical performance, as measured by automated performance metrics (APMs), and outcomes after robot-assisted radical prostatectomy (RARP). Methods We compared APMs (instrument tracking, EndoWrist (R) articulation, and system events data) and clinical outcomes for cases with varying resident involvement. Four of 12 standardized RARP steps were designated critical ("cardinal") steps. Comparison 1: cases where the attending surgeon performed all four cardinal steps (Group A) and cases where a trainee was involved in at least one cardinal step (Group B). Comparison 2, where Group A is split into Groups C and D: cases where attending performs the whole case (Group C) vs. cases where a trainee performed at least one non-cardinal step (Group D). Mann-WhitneyUand Chi-squared tests were used for comparisons. Results Comparison 1 showed significant differences in APM profiles including camera movement time, third instrument usage, dominant instrument moving time, velocity, articulation, as well as non-dominant instrument moving time and articulation (all favoring Group Ap < 0.05). There was a significant difference in re-admission rates (10.9% in Group A vs 0% in Group B,p < 0.02), but not for post-operative outcomes. Comparison 2 demonstrated a significant difference in dominant instrument articulation (p < 0.05) but not in post-operative outcomes. Conclusions Trainee involvement in RARP is safe. The degree of trainee involvement does not significantly affect major clinical outcomes. APM profiles are less efficient when trainees perform at least one cardinal step but not during non-cardinal steps.