scholarly journals How to Bring Surgery to the Next Level: Interpretable Skills Assessment in Robotic-Assisted Surgery

2020 ◽  
Vol 36 (6) ◽  
pp. 463-470
Author(s):  
Kristen C. Brown ◽  
Kiran D. Bhattacharyya ◽  
Sue Kulason ◽  
Aneeq Zia ◽  
Anthony Jarc
Keyword(s):  
Logistic Regression ◽  
Technical Skills ◽  
Technical Skill ◽  
Small Subset ◽  
Robotic Assisted ◽  
Robotic Assisted Surgery ◽  
Surgical Trainees ◽  
Objective Metrics ◽  
Data Driven Approach ◽  
Similar Accuracy

<b><i>Introduction:</i></b> A surgeon’s technical skills are an important factor in delivering optimal patient care. Most existing methods to estimate technical skills remain subjective and resource intensive. Robotic-assisted surgery (RAS) provides a unique opportunity to develop objective metrics using key elements of intraoperative surgeon behavior which can be captured unobtrusively, such as instrument positions and button presses. Recent studies have shown that objective metrics based on these data (referred to as objective performance indicators [OPIs]) correlate to select clinical outcomes during robotic-assisted radical prostatectomy. However, the current OPIs remain difficult to interpret directly and, therefore, to use within structured feedback to improve surgical efficiencies. <b><i>Methods:</i></b> We analyzed kinematic and event data from da Vinci surgical systems (Intuitive Surgical, Inc., Sunnyvale, CA, USA) to calculate values that can summarize the use of robotic instruments, referred to as OPIs. These indicators were mapped to broader technical skill categories of established training protocols. A data-driven approach was then applied to further sub-select OPIs that distinguish skill for each technical skill category within each training task. This subset of OPIs was used to build a set of logistic regression classifiers that predict the probability of expertise in that skill to identify targeted improvement and practice. The final, proposed feedback using OPIs was based on the coefficients of the logistic regression model to highlight specific actions that can be taken to improve. <b><i>Results:</i></b> We determine that for the majority of skills, only a small subset of OPIs (2–10) are required to achieve the highest model accuracies (80–95%) for estimating technical skills within clinical-like tasks on a porcine model. The majority of the skill models have similar accuracy as models predicting overall expertise for a task (80–98%). Skill models can divide a prediction into interpretable categories for simpler, targeted feedback. <b><i>Conclusion:</i></b> We define and validate a methodology to create interpretable metrics for key technical skills during clinical-like tasks when performing RAS. Using this framework for evaluating technical skills, we believe that surgical trainees can better understand both what can be improved and how to improve.

Robotic-Assisted Surgery Training (RAST) Program: An Educational Research Protocol

2021 ◽  
Author(s):  
Maria Castaldi ◽  
Mathias Palmer ◽  
Jorge Con ◽  
Ziad Abouezzi ◽  
Rifat Latifi ◽  
...  
Keyword(s):  
Educational Research ◽  
Operating Room ◽  
Operating Time ◽  
Technical Skills ◽  
Educational Environment ◽  
Research Protocol ◽  
Robotic Assisted ◽  
Surgery Training ◽  
Robotic Assisted Surgery ◽  
Over Time

Technology has had a dramatic impact on how diseases are diagnosed and treated. Although cut, sew, and tie remain the staples of surgical craft, new technical skills are required. While there is no replacement for live operative experience, training outside the operating room offers structured educational opportunities and stress modulation. A stepwise program for acquiring new technical skills required in robotic surgery involves three modules: ergonomic, psychomotor, and procedural. This is a prospective, educational research protocol aiming at evaluating the responsiveness of general surgery residents in Robotic-Assisted Surgery Training (RAST). Responsiveness is defined as change in performance over time. Performance is measured by the following content-valid metrics for each module. Module 1 proficiency in ergonomics includes: cart deploy, boom control, cart driving, camera port docking, targeting anatomy, flex joint, clearance joint and port nozzle adjusting, and routine and emergent undocking. Module 2 proficiency in psychomotor skills includes tissue handling, accuracy error, knot quality, and operating time. Module 3 proficiency in procedural skills prevents deviations from standardized sequential procedural steps in order to test length of specimen resection, angle for transection, vessel stump length post ligation, distance of anastomosis from critical landmarks, and proximal and distal resection margins. Resident responsiveness over time will be assessed comparing the results of baseline testing with final testing. Educational interventions will include viewing one instructional video prior to module commencement, response to module-specific multiple-choice questions, and individual weekly training sessions with a robotic instructor in the operating room. Residents will progress through modules upon successful final testing and will evaluate the educational environment with the Dundee Ready Educational Environment Measure (DREEM) inventory. The RAST program protocol outlined herein is an educational challenge with the primary endpoint to provide evidence that formal instruction has an impact on proficiency and safety in executing robotic skills.

scholarly journals RAS-NOTECHS: validity and reliability of a tool for measuring non-technical skills in robotic-assisted surgery settings

2021 ◽  
Author(s):  
Julia Schreyer ◽  
Amelie Koch ◽  
Annika Herlemann ◽  
Armin Becker ◽  
Boris Schlenker ◽  
...  
Keyword(s):  
Assessment Tool ◽  
Qualitative Interviews ◽  
Surgical Care ◽  
Technical Skills ◽  
Rater Agreement ◽  
Validity And Reliability ◽  
Delphi Consensus ◽  
Robotic Assisted ◽  
Robotic Assisted Surgery ◽  
Strong Agreement

Abstract Background Non-technical skills (NTS) are essential for safe surgical practice as they impact workflow and patient outcomes. Observational tools to measure operating room (OR) teams’ NTS have been introduced. However, there are none that account for the specific teamwork challenges introduced by robotic-assisted surgery (RAS). We set out to develop and content-validate a tool to assess multidisciplinary NTS in RAS. Methodology Stepwise, multi-method procedure. Observations in different surgical departments and a scoping literature review were first used to compile a set of RAS-specific teamwork behaviours. This list was refined and expert validated using a Delphi consensus approach consisting of qualitative interviews and a quantitative survey. Then, RAS-specific behaviours were merged with a well-established assessment tool on OR teamwork (NOTECHS II). Finally, the new tool—RAS-NOTECHS—was applied in standardized observations of real-world procedures to test its reliability (inter-rater agreement via intra-class correlations). Results Our scoping review revealed 5242 articles, of which 21 were included based on pre-established inclusion criteria. We elicited 16 RAS-specific behaviours from the literature base. These were synthesized with further 18 behavioural markers (obtained from 12 OR-observations) into a list of 26 behavioural markers. This list was reviewed by seven RAS experts and condensed to 15 expert-validated RAS-specific behavioural markers which were then merged into NOTECHS II. For five observations of urologic RAS procedures (duration: 13 h and 41 min), inter-rater agreement for identification of behavioural markers was strong. Agreement of RAS-NOTECHS scores indicated moderate to strong agreement. Conclusions RAS-NOTECHS is the first observational tool for multidisciplinary NTS in RAS. In preliminary application, it has been shown to be reliable. Since RAS is rapidly increasing and challenges for effective and safe teamwork remain at the forefront of quality and safety of surgical care, RAS-NOTECHS may contribute to training and improvement efforts in technology-facilitated surgeries.

Debriefing Surgeons on Non-Technical Skills in the Operating Room - Results from a Pilot Study

2007 ◽  
Vol 51 (11) ◽  
pp. 663-667
Author(s):  
S. Yule ◽  
R. Flin ◽  
N. Maran ◽  
D. Rowley ◽  
G. Youngson ◽  
...  
Keyword(s):  
Operating Room ◽  
Cognitive Skills ◽  
Technical Skills ◽  
Assessment Tools ◽  
Valuable Adjunct ◽  
Surgical Trainees ◽  
Operative Surgery ◽  
Enhance Patient Safety ◽  
Behaviour Rating ◽  
Current Assessment

Briefing and debriefing are common practices for safety in high risk industries but are not systematically done in surgery. Regular debriefing of performance after operative surgery can greatly assist surgical trainees' development and help optimize learning from the limited time they spend in the Operating Room (OR). We developed and tested the NOTSS (Non-Technical Skills for Surgeons) behaviour rating system with subject matter experts. It allows surgeons to observe trainees' behaviour in the OR and provide them with structured feedback for improvement. This paper describes process of debriefing and the results of a pilot usability trial. The majority of participants reported that the NOTSS system was useful for debriefing trainees, provided a common language to discuss non-technical skills, and was a valuable adjunct to current assessment tools. Some surgeons found interpersonal skills more difficult to rate than cognitive skills. 73% felt that routine use of the system would enhance patient safety.

scholarly journals Detailed cost of robotic-assisted surgery in the Australian public health sector: from implementation to a multi-specialty caseload

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kate McBride ◽  
Daniel Steffens ◽  
Christina Stanislaus ◽  
Michael Solomon ◽  
Teresa Anderson ◽  
...  
Keyword(s):  
Public Sector ◽  
Health Sector ◽  
Public Hospitals ◽  
Fixed Costs ◽  
Tertiary Referral Hospital ◽  
Robotic Assisted ◽  
The Public ◽  
Robotic Assisted Surgery ◽  
Specific Implementation ◽  
Theatre Utilisation

Abstract Background A barrier to the uptake of robotic-assisted surgery (RAS) continues to be the perceived high costs. A lack of detailed costing information has made it difficult for public hospitals in particular to determine whether use of the technology is justified. This study aims to provide a detailed description of the patient episode costs and the contribution of RAS specific costs for multiple specialties in the public sector. Methods A retrospective descriptive costing review of all RAS cases undertaken at a large public tertiary referral hospital in Sydney, Australia from August 2016 to December 2018 was completed. This included RAS cases within benign gynaecology, cardiothoracic, colorectal and urology, with the total costs described utilizing various inpatient costing data, and RAS specific implementation, maintenance and consumable costs. Results Of 211 RAS patients, substantial variation was found between specialties with the overall median cost per patient being $19,269 (Interquartile range (IQR): $15,445 to $32,199). The RAS specific costs were $8828 (46%) made up of fixed costs including $4691 (24%) implementation and $2290 (12%) maintenance, both of which are volume dependent; and $1848 (10%) RAS consumable costs. This was in the context of 37% robotic theatre utilisation. Conclusions There is considerable variation across surgical specialties for the cost of RAS. It is important to highlight the different cost components and drivers associated with a RAS program including its dependence on volume and how it fits within funding systems in the public sector.

scholarly journals Robotic natural orifice specimen extraction surgery versus traditional robotic-assisted surgery (NOTR) for patients with colorectal cancer: a study protocol for a randomized controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Rui Luo ◽  
Fangfang Zheng ◽  
Haobo Zhang ◽  
Weiquan Zhu ◽  
Penghui He ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Natural Orifice ◽  
Specimen Extraction ◽  
Natural Orifice Specimen Extraction ◽  
Robotic Assisted ◽  
Randomized Controlled ◽  
Robotic Assisted Surgery ◽  
Secondary Outcomes

Abstract Background Natural orifice specimen extraction surgery for colorectal cancer has been introduced in order to reduce the abdominal incision, demonstrating major development potential in minimally invasive surgery. We are conducting this randomized controlled trial to assess whether robotic NOSES is non-inferior to traditional robotic-assisted surgery for patients with colorectal cancer in terms of primary and secondary outcomes. Method/design Accordingly, a prospective, open-label, randomized controlled, parallel-group, multicenter, and non-inferiority trial will be conducted to discuss the safety and efficacy of robotic natural orifice extraction surgery compared to traditional robotic-assisted surgery. Here, 550 estimated participants will be enrolled to have 80% power to detect differences with a one-sided significance level of 0.025 in consideration of the non-inferiority margin of 10%. The primary outcome is the incidence of surgical complications, which will be classified using the Clavien-Dindo system. Discussion This trial is expected to reveal whether robotic NOSES is non-inferior to traditional robotic-assisted surgery, which is of great significance in regard to the development of robotic NOSES for patients with colorectal cancer in the minimally invasive era. Furthermore, robotic NOSES is expected to exhibit superiority to traditional robotic-assisted surgery in terms of both primary and secondary outcomes. Trial registration ClinicalTrials.govNCT04230772. Registered on January 15, 2020.

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