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Effect of surgeon experience and bony pelvic dimensions on surgical performance and patient outcomes in robot-assisted radical prostatectomy

Jian Chen, Tiffany Chu, Saum Ghodoussipour, Sean Bowman, Heetabh Patel, Kevin King, Andrew J Hung
BJU International 2019 July 2

OBJECTIVES: To evaluate the effects of surgeon experience, body habitus, and bony pelvic dimensions on surgeon performance and patient outcomes after robot-assisted laparoscopic prostatectomy (RARP).

SUBJECTS AND METHODS: Pelvic dimensions for 78 RARP patients were measured on preoperative MRI and CT imaging by three radiologists. Surgeon automated performance metrics (APMs) (instrument motion tracking and system events data, i.e. camera movement, third arm swap, energy use) were obtained by a systems data recorder (Intuitive Surgical) during RARP. Two analyses were performed: Analysis 1: Examined effects of patient characteristics, pelvic dimensions, and prior surgeon RARP caseload on APMs using linear regression. Analysis 2: The effects of patient body habitus, bony pelvic measurement, and surgeon experience on short- and long-term outcomes were analyzed by multivariable regression.

RESULTS: Analysis 1 showed that while surgeon experience affected the greatest number of APMs (P<0.044), patient BMI, bony pelvic dimensions, and prostate size also affected APMs during each surgical step (p<0.043, p<0.046, p<0.034, respectively). Analysis 2 showed that surgery duration was significantly affected by pelvic depth (β=13.7, p=0.039) and prostate volume (β=0.5, p=0.024). A wider and shallower pelvis was less likely to result in a positive margin (odds ratio=0.25, 95% confidence interval 0.09-0.72). On multivariate analysis, urinary continence recovery was associated with surgeon's prior RARP experience (hazard ratio =2.38 (95% CI 1.18-4.81), p=0.015), but not on pelvic dimensions (hazard ratio = 1.44, 95% CI 0.95-2.17).

CONCLUSION: Limited surgical workspace due to a narrower and deeper pelvis does affect surgeon performance and patient outcomes, most notably in increased surgery time and an increased positive margin rate. This article is protected by copyright. All rights reserved.


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