Presentation Authors: Justin Collins*, Melle, Belgium, Anthony Gallagher, Cork, Ireland, Markus Graefen, Hamburg, Germany, Alessandro Larcher, Milano, Italy, Paolo Dell'Oglio, Aalst, Belgium, Peter Wiklund, Stockholm, Sweden, Alexander Mottrie, Aalst, Belgium
Introduction: It is recognised inadequate training in robotic surgery results in increased complications and costs. Standardising modular training with defined steps and the errors to avoid will enable proficiency-based progression (PBP) training. We aimed to achieve consensus amongst experts on the key steps of RARP and the associated errors and critical errors (CE) related to those steps.
Methods: The project was carried out in phases: a systematic review of current evidence, 5 experts to review videos of expert and trainee surgeons to define the metrics. A panel of 18 experts then validated the key metrics with a modified Delphi process. Consensus opinion was defined as â‰¥80% agreement. We compared changes in the number of metric units before and after the Delphi meeting for statistical significance with Wilcoxon Signed Rank Tests. The relationship between the number of metric units before and after was assessed with Pearsonâ€™s Product Moment Correlation Coefficient.
Results: Experts came from 11 European countries. 15 out of 18 (83%) were fellowship trained, median no. of RARP cases performed 1500. Table 1 summarises the 12 phases of RARP identified and agreed by the Delphi panel. Summarising the procedure metric units i.e. Steps, Errors and Critical Errors (CE) before and after the Delphi process. The mean number of Steps and Errors increased during the Delphi (Steps mean increase = 0.083 (SD=0.29) and Errors mean increase = 1.71 (SD=4.32). The mean number of CE decreased (0.5 (SD=1.1) but didn't reach statistical significance (Steps mean increase: Z= -1.0, p=0.317; Mean Errors mean increase: Z= -1.47, p=0.142; Mean number of CE decrease: Z= -1.63, p=0.102). Metric units before and after the Delphi were strongly correlated (Steps, r=0.998, p < 0.000; Errors, r=0.811, p < 0.000; Critical Errors, r=0.899, p < 0.000)._x000D_
Table 1: Summary of phases and Delphi modifications( )*modifications NR = Not Relevenat
Conclusions: Using a modified Delphi process we achieved international consensus among European experts for a PBP approach to RARP training within a short time frame. We have described a standardised definition of optimised surgical technique in RARP and the errors to avoid. These metrics lay the foundation for developing PBP training in RARP.