Presentation Authors: Micha Titus, Andrew Chen, Jian Chen*, Saum Ghodoussipour, Andrew Hung, Los Angeles, CA
Introduction: Teaching hospitals balance resident training with optimizing patient outcomes. In this study, we expand on work that investigated if clinical outcomes differ with trainee involvement. We inspected whole-case automated performance metrics (APMs), patient demographics and clinical outcome data to determine the impact of trainees' console performance in four steps of the robot-assisted radical prostatectomy (RARP) that we believe are likely to drive outcomes. These &[prime]cardinal steps&[prime] are the prostatic pedicle dissection, apical dissection, bladder neck dissection and the vesico-urethral anastomosis.
Methods: Clinical data was collected prospectively. A systems data recorder (Intuitive Surgical) tracked surgical video and APMs (kinematic and system events data) directly from the da Vinci Si robot. Two comparisons were performed. Comparison 1 compared attending surgeons performing the whole case (Group A, n=21) to cases where attending surgeons performed all cardinal steps with trainee involvement for non-cardinal steps (Group B, n=32). Comparison 2 compared cases with an attending surgeon performing all cardinal steps (Groups A+ B= Group C, n=53) to cases with trainees performing at least one cardinal step (Group D, n=42). Mann-Whitney U test was used to compare clinical outcomes and APMs between groups.
Results: Comparison 1 showed Group A had shorter surgical time (209 v 229 minutes, p=0.048), camera frequency (0.1098 v 0.0962, p=0.03) and instrument angular wrist velocity (0.9386 v 0.8625 radians/minute, p=0.04). Other APMs and clinical outcomes did not differ significantly. Comparison 2 showed that Group C had a shorter surgical time (227 vs 247 minutes, p=0.02) but higher readmission rate (10.9% v 0%, p=0.02) and BMI (29.5 vs. 28.8, p=0.02). Days to continence did not differ between Groups C and D (187 v 166 days, p=0.882) despite more efficient APMs in Group C's (Table).
Conclusions: APM profiles differs when residents are involved in the RARP (both Groups A vs. B and Groups C vs. D), but clinical outcomes are not negatively affected when residents perform non-cardinal steps or at least one cardinal step (except for surgical time). This suggests trainee involvement does not jeopardize patient safety or clinical outcomes.
Source of Funding: This study was funded in part by an Intuitive Surgical Clinical Grant; Intuitive Surgical provided the systems data recorder.