Introduction: The operating room (OR) is a costly area of hospital operations and the surgeon is often identified as a major source of variability affecting OR efficiency. Surgeons aim to minimize surgery time to not only prevent delays, but also to reduce the likelihood of anesthesia complications. This study aims to evaluate patient and surgeon factors that affect total operative time of robot-assisted radical prostatectomy (RARP).
Methods: A retrospective study was conducted at our institution from 2016-2017. Cases were initially organized by quartile ranking based on total operative time. Each RARP was broken down into 12 steps (Figure 1). If the quartile ranking of a specific step was associated with the quartile ranking of total operative time, this step was further analyzed to determine correlations to surgeon experience (novice < 100 cases, expert > 100 cases) and patient factors. The fastest and slowest quartiles of total operative times were analyzed with Chi-Square for categorical variables and Mann-Whitney U for continuous variables.
Results: Our study included 15 expert (median 375 cases [100 – 2,000]) and 13 novice (30 [5 – 80]) surgeons performing a total of 131 RARP cases. Of the 12 steps, the bladder drop/colon mobilization, anterior bladder neck dissection, apical dissection, vesicourethral anastomosis (VUA), and lymph node dissection (LND) steps were associated with total operative time (Likelihood ratio: 17.35 – 66.21, p < 0.043). Among these significant steps, bladder drop/colon mobilization, anterior bladder neck dissection, and VUA steps were associated with surgeon experience (Likelihood ratio: 13.60 – 37.07, p < 0.001). LND, however, was associated with patient factors. Notable patient factors affecting LND in the slowest quartile of total operative times included higher BMI (Median 30.50 kg/m2 vs 27.17 kg/m2, p < 0.034), higher percentage of high-grade Gleason scores (>7) (33% vs 25%, p < 0.046), and higher number of lymph nodes dissected (Median 20 nodes vs 15 nodes, p < 0.001) compared to the fastest quartile.
Conclusions: Although RARPs vary in duration, certain steps seem to drive shorter or longer total operative times. This study shows that these specific steps are impacted mainly by either surgeon experience or patient factors and should be considered in RARPs to maximize OR efficiency. Source of
