Surgeon Automated Performance Metrics as Predictors of Early Urinary Continence Recovery After Robotic Radical Prostatectomy—A Prospective Bi-institutional Study

Background: During robotic surgeries, kinematic metrics objectively quantify surgeon performance. Objective: To determine whether clinical factors confound the ability of surgeon performance metrics to anticipate urinary continence recovery after robot-assisted radical prostatectomies (RARPs). Desig...

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Main Authors: Andrew J. Hung, Runzhuo Ma, Steven Cen, Jessica H. Nguyen, Xiaomeng Lei, Christian Wagner
Format: Article
Language:English
Published: Elsevier 2021-05-01
Series:European Urology Open Science
Subjects:
Online Access:http://www.sciencedirect.com/science/article/pii/S2666168321000616
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language English
format Article
sources DOAJ
author Andrew J. Hung
Runzhuo Ma
Steven Cen
Jessica H. Nguyen
Xiaomeng Lei
Christian Wagner
spellingShingle Andrew J. Hung
Runzhuo Ma
Steven Cen
Jessica H. Nguyen
Xiaomeng Lei
Christian Wagner
Surgeon Automated Performance Metrics as Predictors of Early Urinary Continence Recovery After Robotic Radical Prostatectomy—A Prospective Bi-institutional Study
European Urology Open Science
Prostatectomy
Urinary continence
Automated performance metrics
Surgeon performance
author_facet Andrew J. Hung
Runzhuo Ma
Steven Cen
Jessica H. Nguyen
Xiaomeng Lei
Christian Wagner
author_sort Andrew J. Hung
title Surgeon Automated Performance Metrics as Predictors of Early Urinary Continence Recovery After Robotic Radical Prostatectomy—A Prospective Bi-institutional Study
title_short Surgeon Automated Performance Metrics as Predictors of Early Urinary Continence Recovery After Robotic Radical Prostatectomy—A Prospective Bi-institutional Study
title_full Surgeon Automated Performance Metrics as Predictors of Early Urinary Continence Recovery After Robotic Radical Prostatectomy—A Prospective Bi-institutional Study
title_fullStr Surgeon Automated Performance Metrics as Predictors of Early Urinary Continence Recovery After Robotic Radical Prostatectomy—A Prospective Bi-institutional Study
title_full_unstemmed Surgeon Automated Performance Metrics as Predictors of Early Urinary Continence Recovery After Robotic Radical Prostatectomy—A Prospective Bi-institutional Study
title_sort surgeon automated performance metrics as predictors of early urinary continence recovery after robotic radical prostatectomy—a prospective bi-institutional study
publisher Elsevier
series European Urology Open Science
issn 2666-1683
publishDate 2021-05-01
description Background: During robotic surgeries, kinematic metrics objectively quantify surgeon performance. Objective: To determine whether clinical factors confound the ability of surgeon performance metrics to anticipate urinary continence recovery after robot-assisted radical prostatectomies (RARPs). Design, setting, and participants: Clinical data (patient characteristics, continence recovery, and treatment factors) and surgeon data from RARPs performed between July 2016 and November 2018 were prospectively collected. Surgeon data included 40 automated performance metrics (APMs) derived from robot systems (instrument kinematics and events) and summarized over each standardized RARP step. The data were collected from two high-volume robotic centers in the USA and Germany. Surgeons from both institutions performed RARPs. The inclusion criteria were consecutive RARPs having both clinical and surgeon data. Intervention: RARP with curative intent to treat prostate cancer. Outcome measurements and statistical analysis: The outcome was 3- and 6-mo urinary continence recovery status. Continence was defined as the use of zero or one safety pad per day. Random forest (SAS HPFOREST) was utilized. Results and limitations: A total of 193 RARPs performed by 20 surgeons were included. Of the patients, 56.7% (102/180) and 73.3% (129/176) achieved urinary continence by 3 and 6 mo after RARP, respectively. The model anticipated continence recovery (area under the curve = 0.74, 95% confidence interval [CI] 0.66–0.81 for 3-mo, and area under the curve = 0.67, 95% CI 0.58–0.76 for 6 mo). Clinical factors, including pT stage, confounded APMs during prediction of continence recovery at 3 mo after RARP (Δβ median –13.3%, interquartile range [–28.2% to –6.5%]). After adjusting for clinical factors, 11/20 (55%) top-ranking APMs remained significant and independent predictors (ie, velocity and wrist articulation during the vesicourethral anastomosis). Limitations included heterogeneity of surgeon/patient data between institutions, although it was accounted for during multivariate analysis. Conclusions: Clinical factors confound surgeon performance metrics during the prediction of urinary continence recovery after RARP. Nonetheless, many surgeon factors are still independent predictors of early continence recovery. Patient summary: Both patient factors and surgeon kinematic metrics, recorded during robotic prostatectomies, impact early urinary continence recovery after robot-assisted radical prostatectomy.
topic Prostatectomy
Urinary continence
Automated performance metrics
Surgeon performance
url http://www.sciencedirect.com/science/article/pii/S2666168321000616
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AT runzhuoma surgeonautomatedperformancemetricsaspredictorsofearlyurinarycontinencerecoveryafterroboticradicalprostatectomyaprospectivebiinstitutionalstudy
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spelling doaj-54bc6a758ade4df9a68991585ea406712021-04-18T06:32:38ZengElsevierEuropean Urology Open Science2666-16832021-05-01276572Surgeon Automated Performance Metrics as Predictors of Early Urinary Continence Recovery After Robotic Radical Prostatectomy—A Prospective Bi-institutional StudyAndrew J. Hung0Runzhuo Ma1Steven Cen2Jessica H. Nguyen3Xiaomeng Lei4Christian Wagner5Center for Robotic Simulation & Education, Catherine & Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Corresponding author. University of Southern California Institute of Urology, 1441 Eastlake Avenue Suite 7416, Los Angeles, CA 90089, USA. Tel. +1 323-865-3700; Fax: +1 323-865-0120.Center for Robotic Simulation & Education, Catherine & Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USADepartment of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USACenter for Robotic Simulation & Education, Catherine & Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USADepartment of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USADepartment of Urology, Pediatric Urology and Urologic Oncology, St. Antonius-Hospital, Gronau, GermanyBackground: During robotic surgeries, kinematic metrics objectively quantify surgeon performance. Objective: To determine whether clinical factors confound the ability of surgeon performance metrics to anticipate urinary continence recovery after robot-assisted radical prostatectomies (RARPs). Design, setting, and participants: Clinical data (patient characteristics, continence recovery, and treatment factors) and surgeon data from RARPs performed between July 2016 and November 2018 were prospectively collected. Surgeon data included 40 automated performance metrics (APMs) derived from robot systems (instrument kinematics and events) and summarized over each standardized RARP step. The data were collected from two high-volume robotic centers in the USA and Germany. Surgeons from both institutions performed RARPs. The inclusion criteria were consecutive RARPs having both clinical and surgeon data. Intervention: RARP with curative intent to treat prostate cancer. Outcome measurements and statistical analysis: The outcome was 3- and 6-mo urinary continence recovery status. Continence was defined as the use of zero or one safety pad per day. Random forest (SAS HPFOREST) was utilized. Results and limitations: A total of 193 RARPs performed by 20 surgeons were included. Of the patients, 56.7% (102/180) and 73.3% (129/176) achieved urinary continence by 3 and 6 mo after RARP, respectively. The model anticipated continence recovery (area under the curve = 0.74, 95% confidence interval [CI] 0.66–0.81 for 3-mo, and area under the curve = 0.67, 95% CI 0.58–0.76 for 6 mo). Clinical factors, including pT stage, confounded APMs during prediction of continence recovery at 3 mo after RARP (Δβ median –13.3%, interquartile range [–28.2% to –6.5%]). After adjusting for clinical factors, 11/20 (55%) top-ranking APMs remained significant and independent predictors (ie, velocity and wrist articulation during the vesicourethral anastomosis). Limitations included heterogeneity of surgeon/patient data between institutions, although it was accounted for during multivariate analysis. Conclusions: Clinical factors confound surgeon performance metrics during the prediction of urinary continence recovery after RARP. Nonetheless, many surgeon factors are still independent predictors of early continence recovery. Patient summary: Both patient factors and surgeon kinematic metrics, recorded during robotic prostatectomies, impact early urinary continence recovery after robot-assisted radical prostatectomy.http://www.sciencedirect.com/science/article/pii/S2666168321000616ProstatectomyUrinary continenceAutomated performance metricsSurgeon performance