Da Vinci surgery skill assessment

A recent article in the Journal of Urology made news, reporting on the novel approach to record da Vinci procedures with the dVLogger, with Andrew Hung, University of Southern California - Health Sciences:

"We explore and validate objective surgeon performance metrics using a novel recorder (“dVLogger”) to directly capture surgeon manipulations on the da Vinci® Surgical System. We present the initial construct and concurrent validation study of objective metrics during preselected steps of robot-assisted radical prostatectomy.

Materials and Methods: Kinematic and events data were recorded for expert (100 or more cases) and novice (less than 100 cases) surgeons performing bladder mobilization, seminal vesicle dissection, anterior vesicourethral anastomosis and right pelvic lymphadenectomy. Expert/novice metrics were compared using mixed effect statistical modeling (construct validation). Expert reviewers blindly rated seminal vesicle dissection and anterior vesicourethral anastomosis using GEARS (Global Evaluative Assessment of Robotic Skills). Intraclass correlation measured inter-rater variability. Objective metrics were correlated to corresponding GEARS metrics using Spearman’s test (concurrent validation).

Results: The performance of 10 experts (mean 810 cases, range 100 to 2,000) and 10 novices (mean 35 cases, range 5 to 80) was evaluated in 100 robot-assisted radical prostatectomy cases. For construct validation the experts completed operative steps faster (p <0 .001="" 0.6-0.7.="" 200="" 300="" 3="" 500="" a="" aggregate="" all="" among="" anastomosis.="" anastomosis="" and="" anterior="" associations="" camera="" cases="" concurrent="" correlation="" dissection="" distance="" dominant-to-nondominant="" except="" experience="" expert="" experts="" for="" frequent="" gears="" greater="" had="" idle="" instrument="" intraclass="" kinematic="" length="" less="" low="" median="" metrics.="" metrics="" more="" movements="" nbsp="" of="" p="" path="" range="" ratio="" reviewers="" seminal="" shorter="" steps="" the="" time="" to="" travel="" validation="" vesicle="" vesicourethral="" was="" with="">

Conclusion: Objective metrics revealed experts to be more efficient and directed during preselected steps of robot-assisted radical prostatectomy. Objective metrics had limited associations to GEARS. These findings lay the foundation for developing standardized metrics for surgeon training and assessment."

Source: The Journal of Urology