Standardizing the suturing of an anastomosis

 A really cool article appeared from the USC group in the Journal of Urology: "Use of Automated Performance Metrics to Measure Surgeon Performance during Robotic Vesicourethral Anastomosis and Methodical Development of a Training Tutorial" on the autonomous performance assessment of a surgical subtask: suturing.

Abstract:

"Purpose: We sought to develop and validate automated performance metrics to measure surgeon performance of vesicourethral anastomosis during robotic assisted radical prostatectomy. Furthermore, we sought to methodically develop a standardized training tutorial for robotic vesicourethral anastomosis. 

Materials and Methods: We captured automated performance metrics for motion tracking and system events data, and synchronized surgical video during robotic assisted  radical  prostatectomy.  Nonautomated  performance  metrics  were manually annotated by video review. Automated and nonautomated perfor- mance metrics were compared between experts with 100 or more console cases and novices with fewer than 100 cases. Needle driving gestures were classified and compared. We then applied task deconstruction, cognitive task analysis and Delphi methodology to develop a standardized robotic vesicourethral anasto- mosis tutorial. 

Results: We analyzed 70 vesicourethral anastomoses with a total of 1,745 stitches. For automated performance metrics experts outperformed novices in completion time (p < 0.01), EndoWrist articulation (p < 0.03), instrument movement efficiency (p <0 .02="" 0.01="" 14="" 1="" 2.="" 2="" 58="" 66="" 8="" a="" achieved="" after="" among="" and="" angle="" associated="" attempts="" camera="" common="" consensus="" contained="" driver="" driving="" each="" efficiency="" entry="" expert="" experts="" fewer="" figures.="" finalized="" for="" gestures.="" gestures="" had="" identified="" including="" less="" lower="" lt="" manipulation="" metrics="" more="" nbsp="" needle="" nonau-="" optimal="" p="" performance="" positioning="" random="" robotic="" round="" rounds="" statements="" surgeons="" the="" tissue="" to="" tomated="" trauma="" tutorial="" was="" we="" were="" with="">

Conclusions: Automated performance metrics can distinguish surgeon expertise during vesicourethral anastomosis. The expert vesicourethral anastomosis technique was associated with more efficient movement and less tissue trauma. Standardizing robotic vesicourethral anastomosis and using a methodically developed tutorial may help improve robotic surgical training.

Source: Journal of Urology, Surgical Products Mag