Surgical Phase Duration in Robot-Assisted Partial Nephrectomy: A Surgical Data Science Exploration for Clinical Relevance

Abstract

(1) Background: Surgical phases form the basic building blocks for surgical skill assessment, feedback, and teaching. The phase duration itself and its correlation with clinical parameters at diagnosis have not yet been investigated. Novel commercial platforms provide phase indications but have not been assessed for accuracy yet. (2) Methods: We assessed 100 robot-assisted partial nephrectomy videos for phase durations based on previously defined proficiency metrics. We developed an annotation framework and subsequently compared our annotations to an existing commercial solution (Touch Surgery, Medtronic™). We subsequently explored clinical correlations between phase durations and parameters derived from diagnosis and treatment. (3) Results: An objective and uniform phase assessment requires precise definitions derived from an iterative revision process. A comparison to a commercial solution shows large differences in definitions across phases. BMI and the duration of renal tumor identification are positively correlated, as are tumor complexity and both tumor excision and renorrhaphy duration. (4) Conclusions: The surgical phase duration can be correlated with certain clinical outcomes. Further research should investigate whether the retrieved correlations are also clinically meaningful. This requires an increase in dataset sizes and facilitation through intelligent computer vision algorithms. Commercial platforms can facilitate this dataset expansion and help unlock the full potential, provided that the phase annotation details are disclosed.

Minimising warm ischaemia time during robot-assisted partial nephrectomy. A video-based assessment of tumour excision, kidney reconstruction and intermediate time

“…Previous studies have assessed the importance of SVR as De Backer et al [3] did for 100 RPNs and showed that surgical phase duration can be correlated with certain clinical outcomes. They found BMI and the duration of renal tumour identification to positively correlate, as higher BMI involves often more intraabdominal fatty tissue.…”

“…Surgical video review (SVR) is an emerging tool for assessing patient outcomes [3], especially in complex surgeries such as robot-assisted partial nephrectomy (RAPN). Robotic surgery platforms enable high-quality video recordings, providing greater magnification and closer views of anatomical details.…”

Privacy-proof Live Surgery Streaming

“…I n recent years, minimally invasive surgery (MIS) video has become central to enabling live streaming, telementoring, post hoc case evaluation, skill assessment, and novel technological advancements through artificial intelligence (AI), virtual reality, and robotic automation. 1,2 On a legal or ethical basis, video anonymization is essential for sharing data across institutions. 3,4 This anonymization is currently limited to manually removing patient metadata, including names and other identifiable information, such as data and recording locations from file names only.…”

“…Furthermore, the advent of AI for surgical video analysis requires anonymized video sharing with technical people who have no role in the patient-physician relationship. From an AI-engineering perspective, automated anonymization is required, as it facilitates the creation of large and varied data sets, it is a preprocessing step for AI-assisted video analysis, 2,8 and it speeds up the labeling efforts for supervised AI techniques. 9 Manual video processing, including out-of-body image reviews, is time-consuming and prone to human error.…”

“…In recent years, minimally invasive surgery (MIS) video has become central to enabling live streaming, telementoring, post hoc case evaluation, skill assessment, and novel technological advancements through artificial intelligence (AI), virtual reality, and robotic automation 1,2 . On a legal or ethical basis, video anonymization is essential for sharing data across institutions 3,4 .…”