Kinematic data profile and clinical outcomes in robotic inguinal hernia repairs: a pilot study.
Kinematic data
Objective performance indicators
Robotic inguinal hernia repair
Surgeon experience
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
10 2023
10 2023
Historique:
received:
10
04
2023
accepted:
05
07
2023
medline:
27
9
2023
pubmed:
21
7
2023
entrez:
20
7
2023
Statut:
ppublish
Résumé
Surgical training requires clinical knowledge and technical skills to operate safely and optimize clinical outcomes. Technical skills are hard to measure. The Intuitive Data Recorder (IDR), (Sunnyvale, CA) allows for the measurement of technical skills using objective performance indicators (OPIs) from kinematic event data. Our goal was to determine whether OPIs improve with surgeon experience and whether they are correlated with clinical outcomes for robotic inguinal hernia repair (RIHR). The IDR was used to record RIHRs from six surgeons. Data were obtained from 98 inguinal hernia repairs from February 2022 to February 2023. Patients were called on postoperative days 5-10 and asked to take the Carolina Comfort Scale (CCS) survey to evaluate acute clinical outcomes. A Pearson test was run to determine correlations between OPIs from the IDR with a surgeon's yearly RIHR experience and with CCS scores. Linear regression was then run for correlated OPIs. Multiple OPIs were correlated with surgeon experience. Specifically, for the task of peritoneal flap exploration, we found that 23 OPIs were significantly correlated with surgeons' 1-year RIHR case number. Total angular motion distance of the left arm instrument had a correlation of - 0.238 (95% CI - 0.417, - 0.042) for RIHR yearly case number. Total angular motion distance of right arm instrument was also negatively correlated with RIHR in 1 year with a correlation of - 0.242 (95% CI - 0.420, - 0.046). For clinical outcomes, wrist articulation of the surgeon's console positively correlated with acute sensation scores from the CCS with a correlation of 0.453 (95% CI 0.013, 0.746). This study defines multiple OPIs that correlate with surgeon experience and with outcomes. Using this knowledge, surgical simulation platforms can be designed to teach patterns to surgical trainees that are associated with increased surgical experience and with improved postoperative outcomes.
Sections du résumé
BACKGROUND
Surgical training requires clinical knowledge and technical skills to operate safely and optimize clinical outcomes. Technical skills are hard to measure. The Intuitive Data Recorder (IDR), (Sunnyvale, CA) allows for the measurement of technical skills using objective performance indicators (OPIs) from kinematic event data. Our goal was to determine whether OPIs improve with surgeon experience and whether they are correlated with clinical outcomes for robotic inguinal hernia repair (RIHR).
METHODS
The IDR was used to record RIHRs from six surgeons. Data were obtained from 98 inguinal hernia repairs from February 2022 to February 2023. Patients were called on postoperative days 5-10 and asked to take the Carolina Comfort Scale (CCS) survey to evaluate acute clinical outcomes. A Pearson test was run to determine correlations between OPIs from the IDR with a surgeon's yearly RIHR experience and with CCS scores. Linear regression was then run for correlated OPIs.
RESULTS
Multiple OPIs were correlated with surgeon experience. Specifically, for the task of peritoneal flap exploration, we found that 23 OPIs were significantly correlated with surgeons' 1-year RIHR case number. Total angular motion distance of the left arm instrument had a correlation of - 0.238 (95% CI - 0.417, - 0.042) for RIHR yearly case number. Total angular motion distance of right arm instrument was also negatively correlated with RIHR in 1 year with a correlation of - 0.242 (95% CI - 0.420, - 0.046). For clinical outcomes, wrist articulation of the surgeon's console positively correlated with acute sensation scores from the CCS with a correlation of 0.453 (95% CI 0.013, 0.746).
CONCLUSIONS
This study defines multiple OPIs that correlate with surgeon experience and with outcomes. Using this knowledge, surgical simulation platforms can be designed to teach patterns to surgical trainees that are associated with increased surgical experience and with improved postoperative outcomes.
Identifiants
pubmed: 37474824
doi: 10.1007/s00464-023-10285-6
pii: 10.1007/s00464-023-10285-6
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
8035-8042Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
Birkmeyer JD, Finks JF, O’Reilly A, Oerline M, Carlin AM, Nunn AR, Dimick J, Banerjee M, Birkmeyer NJO (2013) Surgical skill and complication rates after bariatric surgery. N Engl J Med 369:1434–1442. https://doi.org/10.1056/nejmsa1300625
doi: 10.1056/nejmsa1300625
pubmed: 24106936
Tousignant MR, Liu X, ErshadLangroodi M, Jarc AM (2022) Identification of main influencers of surgical efficiency and variability using task-level objective metrics: a five-year robotic sleeve gastrectomy case series. Front Surg. https://doi.org/10.3389/fsurg.2022.756522
doi: 10.3389/fsurg.2022.756522
pubmed: 35586509
pmcid: 9108208
Hung AJ, Oh PJ, Chen J, Ghodoussipour S, Lane C, Jarc A, Gill IS (2019) Experts vs super-experts: differences in automated performance metrics and clinical outcomes for robot-assisted radical prostatectomy. BJU Int 123:861–868. https://doi.org/10.1111/BJU.14599
doi: 10.1111/BJU.14599
pubmed: 30358042
Fecso AB, Kuzulugil SS, Babaoglu C, Bener AB, Grantcharov TP (2018) Relationship between intraoperative non-technical performance and technical events in bariatric surgery. Br J Surg 105:1044–1050. https://doi.org/10.1002/BJS.10811
doi: 10.1002/BJS.10811
pubmed: 29601079
Chen A, Ghodoussipour S, Titus MB, Nguyen JH, Chen J, Ma R, Hung AJ (2020) Comparison of clinical outcomes and automated performance metrics in robot-assisted radical prostatectomy with and without trainee involvement. World J Urol 38:1615–1621. https://doi.org/10.1007/S00345-019-03010-3
doi: 10.1007/S00345-019-03010-3
pubmed: 31728671
Goldenberg MG, Lee JY, Kwong JCC, Grantcharov TP, Costello A (2018) Implementing assessments of robot-assisted technical skill in urological education: a systematic review and synthesis of the validity evidence. BJU Int 122:501–519. https://doi.org/10.1111/BJU.14219
doi: 10.1111/BJU.14219
pubmed: 29603869
Azari D, Greenberg C, Pugh C, Wiegmann D, Radwin R (2019) In search of characterizing surgical skill. J Surg Educ 76:1348–1363. https://doi.org/10.1016/J.JSURG.2019.02.010
doi: 10.1016/J.JSURG.2019.02.010
pubmed: 30890315
Brown KC, Bhattacharyya KD, Kulason S, Zia A, Jarc A (2020) How to bring surgery to the next level: interpretable skills assessment in robotic-assisted surgery. Visc Med 36:463–470. https://doi.org/10.1159/000512437
doi: 10.1159/000512437
pubmed: 33447602
pmcid: 7768128
Hung AJ, Chen J, Jarc A, Hatcher D, Djaladat H, Gill IS (2018) Development and validation of objective performance metrics for robot-assisted radical prostatectomy: a pilot study. J Urol 199:296–304. https://doi.org/10.1016/J.JURO.2017.07.081
doi: 10.1016/J.JURO.2017.07.081
pubmed: 28765067
Primatesta P, Goldacre MJ (1996) Inguinal hernia repair: incidence of elective and emergency surgery, readmission and mortality. Int J Epidemiol 25:835–894. https://doi.org/10.1093/ije/25.4.835
doi: 10.1093/ije/25.4.835
pubmed: 8921464
Maisonneuve JJ, Yeates D, Goldacre MJ (2015) Trends in operation rates for inguinal hernia over five decades in England: database study. Hernia 19:713–718. https://doi.org/10.1007/S10029-014-1314-9/TABLES/2
doi: 10.1007/S10029-014-1314-9/TABLES/2
pubmed: 25367199
Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O’Neal L, McLeod L, Delacqua G, Delacqua F, Kirby J, Duda SN (2019) The REDCap consortium: building an international community of software platform partners. J Biomed Inform. https://doi.org/10.1016/J.JBI.2019.103208
doi: 10.1016/J.JBI.2019.103208
pubmed: 31078660
pmcid: 7254481
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap): a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42:377–381. https://doi.org/10.1016/J.JBI.2008.08.010
doi: 10.1016/J.JBI.2008.08.010
pubmed: 18929686
Heniford BT, Walters AL, Lincourt AE, Novitsky YW, Hope WW, Kercher KW (2008) Comparison of generic versus specific quality-of-life scales for mesh hernia repairs. J Am Coll Surg 206:638–644. https://doi.org/10.1016/J.JAMCOLLSURG.2007.11.025
doi: 10.1016/J.JAMCOLLSURG.2007.11.025
pubmed: 18387468
Heniford BT, Lincourt AE, Walters AL, Colavita PD, Belyansky I, Kercher KW, Sing RF, Augenstein VA (2018) Carolinas comfort scale as a measure of hernia repair quality of life: a reappraisal utilizing 3788 international patients. Ann Surg 267:171–176. https://doi.org/10.1097/SLA.0000000000002027
doi: 10.1097/SLA.0000000000002027
pubmed: 27655239
Toale C, O’Byrne A, Morris M, Kavanagh DO (2022) Defining operative experience targets in surgical training: a systematic review. Surgery 172:1364–1372. https://doi.org/10.1016/J.SURG.2022.07.015
doi: 10.1016/J.SURG.2022.07.015
pubmed: 36038374