The robot doesn’t lie: real-life validation of robotic performance metrics

Quinn, Kristen M.; Chen, Xiao; Runge, Louis T.; Pieper, Heidi; Renton, David; Meara, Michael P.; Collins, Courtney; Griffiths, Claire; Husain, Syed

doi:10.1007/s00464-022-09707-8

Cited by 11 publications

(4 citation statements)

References 13 publications

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“…In contrast, during a study on robotic inguinal hernia repair, objective robot generated performance metrics have been shown to be accurate and more reliable than self-awareness or even faculty surgeons assessment [ 47 ]. This was also concluded by our previous work regarding the use of objective force-based parameters to assess technical skills during laparoscopic skills training [ 29 , 30 , 48 ].…”

Section: Discussionmentioning

confidence: 99%

Crossover-effects in technical skills between laparoscopy and robot-assisted surgery

et al. 2023

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Introduction Robot-assisted surgery is often performed by experienced laparoscopic surgeons. However, this technique requires a different set of technical skills and surgeons are expected to alternate between these approaches. The aim of this study is to investigate the crossover effects when switching between laparoscopic and robot-assisted surgery. Methods An international multicentre crossover study was conducted. Trainees with distinctly different levels of experience were divided into three groups (novice, intermediate, expert). Each trainee performed six trials of a standardized suturing task using a laparoscopic box trainer and six trials using the da Vinci surgical robot. Both systems were equipped with the ForceSense system, measuring five force-based parameters for objective assessment of tissue handling skills. Statistical comparison was done between the sixth and seventh trial to identify transition effects. Unexpected changes in parameter outcomes after the seventh trial were further investigated. Results A total of 720 trials, performed by 60 participants, were analysed. The expert group increased their tissue handling forces with 46% (maximum impulse 11.5 N/s to 16.8 N/s, p = 0.05), when switching from robot-assisted surgery to laparoscopy. When switching from laparoscopy to robot-assisted surgery, intermediates and experts significantly decreased in motion efficiency (time (sec), resp. 68 vs. 100, p = 0.05, and 44 vs. 84, p = 0.05). Further investigation between the seventh and ninth trial showed that the intermediate group increased their force exertion with 78% (5.1 N vs. 9.1 N, p = 0.04), when switching to robot-assisted surgery. Conclusion The crossover effects in technical skills between laparoscopic and robot-assisted surgery are highly depended on the prior experience with laparoscopic surgery. Where experts can alternate between approaches without impairment of technical skills, novices and intermediates should be aware of decay in efficiency of movement and tissue handling skills that could impact patient safety. Therefore, additional simulation training is advised to prevent from undesired events.

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Section: Discussionmentioning

confidence: 99%

Crossover-effects in technical skills between laparoscopy and robot-assisted surgery

et al. 2023

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“…45 Quantitative robot-generated performance metrics, so far a rather unused potential in robot learning curricula, could play a crucial role in improving robotic training. 46 Incorporating these metrics into a curriculum could be an inexpensive and effective way to quantify skill acquisition. Research on learning curves of conventional laparoscopy trainees already demonstrated that use of force, motion and time metrics could indicate progression of skills over time.…”

Section: Discussionmentioning

confidence: 99%

Introducing a novice surgeon to an experienced robotic gynaecological oncology team: an observational cohort study on the impact of a structured curriculum on outcomes of cervical cancer surgery.

Baeten

Hoogendam

Schreuder

et al. 2023

Preprint

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Objective Effect on patient outcomes when introducing a novice robotic surgeon, trained in accordance with a structured learning curriculum, to an experienced robotic surgery team. Design Observational cohort study. Setting Tertiary referral centre. Population Patients with early-stage cervical cancer who were treated with primary robot-assisted surgery between 2007 and 2019. In addition to the 165 patients included in a former analysis, we included a further 61 consecutively treated patients and divided all patients over three groups: early learning phase of 61 procedures (group 1), experienced phase of the 104 procedures thereafter (group 2), and the final 61 procedures during introduction of a novice with structured training (group 3). Methods Risk-adjusted cumulative sum (RA-CUSUM) analysis was performed and patient outcomes between groups were compared. Main Outcome Measures Surgical proficiency based on recurrence, surgical and oncological outcomes. Results Based on RA-CUSUM analysis, no learning curve effect was observed for group 3. Regarding surgical outcomes, mean operation time in group 3 was significantly shorter than group 1 ( p<0.001) and similar to group 2 ( p=0.96). Proportions of intraoperative and postoperative adverse events in group 3 were not significantly different from the experienced group (group 2). Regarding oncological outcomes, the 5-year disease-free survival, disease-specific survival, and overall survival in group 3 were not significantly different from the experienced group. Conclusions Introducing a novice robotic surgeon, who was trained in accordance with a structured learning curriculum, resulted in similar patient outcomes as by experienced surgeons suggesting novices can progress through a learning phase without compromising outcomes of cervical cancer patients.

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“…23 Previous studies have demonstrated a considerable disagreement between the perceptions of attending surgeons and trainees regarding estimating operative participation. 24 Intuitive application allows for comparison of the operating surgeon to the national average for the length of the procedure. Still, trainees can track metrics such as time spent on the console during cases, case timeline and efficiency, instrument choreography, and peer-to-peer comparison when used with a dual surgical console.…”

Section: Cuaj -Original Researchmentioning

confidence: 99%

Graduating resident and fellow readiness for general urologic practice during the COVID-19 pandemic

Waisanen,

Hennig,

Lutnick

et al. 2024

CUAJ

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Introduction: Our goal was to compare the perceived readiness of graduating urologic residents and fellows to program directors (PDs) in U.S.-based postgraduate training programs. Additionally, we set out to assess the impact of COVID-19 on postgraduation plans to pursue fellowship training. Methods: Graduating residents, fellows, and PDs of accredited residency/fellowship programs in the U.S. were surveyed. The ranked preparedness of trainees to perform common urologic procedures was measured using a Likert scale from 1 (not comfortable) to 5 (fully proficient). The impact of COVID-19 was measured using a three-point Likert scale. Chi-squared and Kruskal-Wallis analyses were used to compare the groups. Results: From 93 responders, 21 were residents, 19 were fellows, 24 were residency PDs, and 29 were fellowship PDs. The median levels of comfort for transurethral resection of the prostate, hydrocelectomy, vasectomy, and urethral sling were at or above (≥3) moderate for both PDs and trainees. PDs were more likely to report underperformance for hypospadias repair (60% vs. 39%), penile prosthesis implantation (39% vs. 26%), and orthotopic neobladder formation (57% vs. 18%) than the trainees. Fifty-three (57.0%) of the surveyors felt that COVID-19 did not impact the trainees’ comfort in performing general urologic procedures. COVID-19 influenced trainees' decision to pursue a fellowship or opt to practice as general urologists (p=0.002). Conclusions: Our study suggests there may be a self-reported discrepancy between graduating trainees and their PDs regarding trainees’ comfort levels performing general urologic procedures.

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The robot doesn’t lie: real-life validation of robotic performance metrics

Cited by 11 publications

References 13 publications

Crossover-effects in technical skills between laparoscopy and robot-assisted surgery

Crossover-effects in technical skills between laparoscopy and robot-assisted surgery

Introducing a novice surgeon to an experienced robotic gynaecological oncology team: an observational cohort study on the impact of a structured curriculum on outcomes of cervical cancer surgery.

Graduating resident and fellow readiness for general urologic practice during the COVID-19 pandemic

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