Feasibility of expert and crowd-sourced review of intraoperative video for quality improvement of intracorporeal urinary diversion during robotic radical cystectomy

Introduction: Development of uretero-ileal stricture (UIS) after robotic-assisted radical cystectomy (RARC) may be dependent on surgical technique. Video review of intraoperative technique is an emerging paradigm for surgical quality improvement. We examined whether surgeon-perceived risk of UIS or crowd-sourced assessment of robotic skill are associated with the development of UIS.Methods: We conducted a case-control study comparing the operative technique of uretero-ileal anastomoses resulting in clinically significant UIS with the contralateral anastomosis for the same patient. De-identified videos were analyzed by 1) five high-volume surgeons; and 2) crowd workers (Crowd-Sourced Assessment of Technical Skill, C-SATS) to determine Global Evaluative Assessment of Robotic Skill (GEARS) score. Mantel-Haenszel common odds ratio (OR) estimates were calculated to assess the association between surgeon performance and the development of UIS. Logistic regression models were used to examine the association between GEARS scores and the development of UIS.Results: A total of 10 UIS videos were compared to eight control videos by five surgeons and 2142 crowd workers. Expert surgeons systematically evaluated intraoperative footage, however, no association between the expert mode response and UIS (OR 0.42; 95% confidence interval [CI] 0.05‒3.45; p=0.91) was identified. Crowd-sourced assessment was not predictive of UIS (p=0.62).Conclusions: We used video review to systematically analyze procedure-specific content and technique. The inability of surgeons to predict UIS may reflect the questionnaire, uncontrolled patient factors, or a lack of power. Crowd-sourced GEARS score was unsuccessful in predicting UIS after RARC.

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Surgical Site Infections Following Ambulatory Surgery Procedures

50 Studies Every Anesthesiologist Should Know ◽

10.1093/med/9780190237691.003.0030 ◽

2018 ◽

pp. 158-162

Keyword(s):

Quality Improvement ◽

Surgical Procedures ◽

Ambulatory Surgery ◽

Surgical Site Infections ◽

High Volume ◽

Low Risk ◽

Inpatient Setting ◽

Cost Burden ◽

Actual Number ◽

Clinically Significant

This case focuses on surgical site infections by asking the question: What is the incidence of clinically significant surgical site infections (CS-SSIs) following low- to moderate-risk ambulatory surgery in patients at low risk for surgical complications? This retrospective analysis found that the overall rate of CS-SSIs following ambulatory surgery is relatively low, at approximately 3.09 per 1,000 ambulatory surgical procedures. However, because of the high volume of ambulatory cases annually, the actual number of acute care visits due to CS-SSIs is large in aggregate. More than 90% of the CS-SSIs in this analysis required treatment in an inpatient setting, demonstrating a substantial cost burden. Thus, surgical site infections merit quality improvement efforts to minimize their occurrence.

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Radical cystectomy in muscle invasive bladder cancer: Evolution towards robotic radical cystectomy (experience in a high volume training hospital)

European Urology Supplements ◽

10.1016/s1569-9056(18)33544-9 ◽

2018 ◽

Vol 17 (12) ◽

pp. e2705

Author(s):

M.G. Onaca ◽

H.H.A. Melick ◽

P. Stijns

Keyword(s):

Bladder Cancer ◽

Radical Cystectomy ◽

High Volume ◽

Invasive Bladder Cancer ◽

Cancer Evolution ◽

Muscle Invasive Bladder Cancer ◽

Robotic Radical Cystectomy ◽

Muscle Invasive

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A comparison of pathologic and intermediate term oncologic outcomes following open and robotic radical cystectomy.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.7_suppl.440 ◽

2019 ◽

Vol 37 (7_suppl) ◽

pp. 440-440

Author(s):

Janet Baack Kukreja ◽

Roger Li ◽

Mohamed Seif ◽

Xuemei Wang ◽

Ashish M. Kamat ◽

...

Keyword(s):

Overall Survival ◽

Radical Cystectomy ◽

High Volume ◽

Positive Surgical Margin ◽

Tertiary Referral ◽

Free Survival ◽

Tertiary Referral Center ◽

Referral Center ◽

Robotic Radical Cystectomy ◽

Recurrence Patterns

440 Background: Conflicting data regarding the oncologic efficacy of robotic surgery has led to concerns for possible inferiority. Despite recent prospective results from the RAZOR trial demonstrating non-inferior progression free survival, results from another prospective randomized trial from Memorial Sloan Kettering suggests a possible difference in the pattern of recurrences. We examined our experience with both open (ORC) and robotic radical cystectomy (RRC) with the objective of establishing recurrence patterns and pathologic comparisons at a high volume tertiary referral center. Methods: We performed a retrospective cohort study at a high volume academic tertiary referral center for patients who underwent radical cystectomy (RC) for bladder cancer from 2005 to 2017. The surgical choice of RRC or ORC is based on provider preference. A multivariable analysis was carried out to determine factors predictive of recurrence free survival (RFS) and overall survival after RC. Analysis was done with SAS 9.4. Results: 1813 patients were identified, 10% underwent RRC and no difference in recurrence patterns were found compared to ORC. There was no difference in the severity of pathology distribution between the two cohorts. There was no difference in positive surgical margin status, 2.4% in ORC and 1.1% in RRC. Peritoneal carcinomatosis was seen in 1.1% of ORC and 0.5% in RRC. Shorter RFS was associated with younger age (HR 1.04, 95%CI 1.03-1.05, p<0.001), neoadjuvant chemotherapy (HR1.55 95%CI 1.32-1.82, p<0.001), higher pathologic stage (stage T4 HR 4.38, 95%CI 3.17-6.06, p<0.001), positive lymph nodes at RC (HR 1.82 95%CI 1.53-2.17, p<0.001) and positive surgical margins (HR 1.50 95%CI 1.19-1.89, p<0.001). At a median follow up of 60 months neither progression free or overall survival for ORC compared to RRC was significantly different. Conclusions: The data from this study supports continued use of RRC as a safe oncologic procedure with similar outcomes to ORC.

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Multi-Institutional Analysis of Robotic Radical Cystectomy for Bladder Cancer: Perioperative Outcomes and Complications in 227 Patients

Journal of Laparoendoscopic & Advanced Surgical Techniques ◽

10.1089/lap.2011.0326 ◽

2012 ◽

Vol 22 (1) ◽

pp. 17-21 ◽

Cited By ~ 77

Author(s):

Angela B. Smith ◽

Mathew Raynor ◽

Christopher L. Amling ◽

J. Erik Busby ◽

Erik Castle ◽

...

Keyword(s):

Bladder Cancer ◽

Radical Cystectomy ◽

Institutional Analysis ◽

Perioperative Outcomes ◽

Robotic Radical Cystectomy

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Trajectories of fatigue in actively treated patients with established rheumatoid arthritis starting biologic DMARD therapy

RMD Open ◽

10.1136/rmdopen-2020-001372 ◽

2020 ◽

Vol 6 (3) ◽

pp. e001372

Author(s):

Sella Aarrestad Provan ◽

Brigitte Michelsen ◽

Joseph Sexton ◽

Tillmann Uhlig ◽

Hilde Berner Hammer

Keyword(s):

Rheumatoid Arthritis ◽

Rating Scale ◽

Numeric Rating Scale ◽

Tender Joint Count ◽

Tender Joint ◽

Logistic Regression Models ◽

Patient Reported ◽

Biologic Dmard ◽

Clinically Significant

ObjectivesTo define fatigue trajectories in patients with rheumatoid arthritis (RA) who initiate biological DMARD (bDMARD) treatment, and explore baseline predictors for a trajectory of continued fatigue.MethodsOne-hundred and eighty-four patients with RA initiating bDMARDs were assessed at 0, 1, 2, 3, 6 and 12 months. Swollen and tender joint counts, patient reported outcomes (PROMs), blood samples and ultrasound examinations were collected at each time point. Fatigue was assessed by the fatigue Numeric Rating Scale (0–10) from the Rheumatoid Arthritis Impact of Disease (RAID) questionnaire. Clinically significant fatigue was predefined as fatigue ≥4. Three trajectories of interest were defined according to level of RAID fatigue: no fatigue (≤3 at 5/6 visits), improved fatigue (≥4 at start, but ≤3 at follow-up) and continued fatigue (≥4 at 5/6 visits). Baseline variables were compared between groups by bivariate analyses, and logistic regression models were used to explore baseline predictors of continued vs improved fatigue.ResultsThe majority of patients starting bDMARD therapy followed one of three fatigue trajectories, (no fatigue; n=61, improved; n=33 and continued fatigue; n=53). Patients with continued fatigue were more likely to be anti–citrullinated protein antibody and/or rheumatoid factor positive and had higher baseline PROMs compared to the other groups, while there were no differences between the groups for variables of inflammation including. Patient global, tender joint count and anxiety were predictors for the continued fatigue trajectory.DiscussionA trajectory of continued fatigue was determined by PROMs and not by inflammatory RA disease activity.

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Side docking approach for robotic radical cystectomy with simultaneous urethrectomy

European Urology ◽

10.1016/s0302-2838(21)01619-5 ◽

2021 ◽

Vol 79 ◽

pp. S1768

Author(s):

G. Rebez ◽

O. Runti ◽

F. Traunero ◽

A. Lissiani ◽

N. Pavan ◽

...

Keyword(s):

Radical Cystectomy ◽

Docking Approach ◽

Robotic Radical Cystectomy

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The Diagnostic Yield of Magnetic Resonance Cholangiopancreatography in the Setting of Acute Pancreaticobiliary Disease — A Single Center Experience

Canadian Association of Radiologists Journal ◽

10.1177/08465371211013786 ◽

2021 ◽

pp. 084653712110137

Author(s):

Sultan Yahya ◽

Abdullah Alabousi ◽

Peri Abdullah ◽

Milita Ramonas

Keyword(s):

Magnetic Resonance ◽

Diagnostic Yield ◽

Binary Logistic Regression ◽

Magnetic Resonance Cholangiopancreatography ◽

Significant Discrepancy ◽

Logistic Regression Models ◽

Single Center Experience ◽

New Information ◽

Clinically Significant ◽

Enzyme Elevation

Purpose: To discern whether preceding ultrasound (US) results, patient demographics and biochemical markers can be implemented as predictors of an abnormal Magnetic Resonance Cholangiopancreatography (MRCP) study in the context of acute pancreaticobiliary disease. Methods: A retrospective study was performed assessing US results, age, gender, elevated lipase and biliary enzymes for consecutive patients who underwent an urgent MRCP following an initial US for acute pancreaticobiliary disease between January 2017-December 2018. Multivariable binary logistic regression models were constructed to assess for predictors of clinically significant MRCPs, and discrepant US/MRCP results. Results: A total of 155 patients (mean age 56, 111 females) were included. Age (OR 1.03, P < 0.05), hyperlipasemia (OR 5.33, P < 0.05) and a positive US (OR 40.75, P < 0.05) were found to be independent predictors for a subsequent abnormal MRCP. Contrarily, gender and elevated biliary enzymes were not reliable predictors of an abnormal MRCP, or significant MRCP/US discrepancies. Of 66 cases (43%) of discordant US/MRCPs, half had clinically significant discrepant findings such as newly discovered choledocholithiasis and pancreaticobiliary neoplasia. Age was the sole predictor for a significant US/MRCP discrepancy, with 2% increase in the odds of a significant discrepancy per year of increase in age. Conclusion: An abnormal US, hyperlipasemia and increased age serve as predictors for a subsequent abnormal MRCP, as opposed to gender and biliary enzyme elevation. Age was the sole predictor of a significant US/MRCP discrepancy that provided new information which significantly impacted subsequent management. In the remaining cases, however, MRCP proved useful in reaffirming the clinical diagnosis and avoiding further investigations.

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