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Effect of surgeon experience and bony pelvic dimensions on surgical performance and patient outcomes in robot‐assisted radical prostatectomy
Author(s) -
Chen Jian,
Chu Tiffany,
Ghodoussipour Saum,
Bowman Sean,
Patel Heetabh,
King Kevin,
Hung Andrew J.
Publication year - 2019
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.14857
Subject(s) - medicine , prostatectomy , pelvis , body mass index , confidence interval , magnetic resonance imaging , odds ratio , surgery , radiology , prostate cancer , cancer
Objectives To evaluate the effects of surgeon experience, body habitus, and bony pelvic dimensions on surgeon performance and patient outcomes after robot‐assisted radical prostatectomy ( RARP ). Patients, Subjects and Methods The pelvic dimensions of 78 RARP patients were measured on preoperative magnetic resonance imaging and computed tomography by three radiologists. Surgeon automated performance metrics ( APM s [instrument motion tracking and system events data, i.e., camera movement, third‐arm swap, energy use]) were obtained by a systems data recorder (Intuitive Surgical, Sunnyvale, CA, USA) during RARP . Two analyses were performed: Analysis 1, examined effects of patient characteristics, pelvic dimensions and prior surgeon RARP caseload on APM s using linear regression; Analysis 2, the effects of patient body habitus, bony pelvic measurement, and surgeon experience on short‐ and long‐term outcomes were analysed by multivariable regression. Results Analysis 1 showed that while surgeon experience affected the greatest number of APM s ( P < 0.044), the patient's body mass index , bony pelvic dimensions, and prostate size also affected APM s during each surgical step ( P < 0.043, P < 0.046, P < 0.034, respectively). Analysis 2 showed that RARP duration was significantly affected by pelvic depth (β = 13.7, P = 0.039) and prostate volume (β = 0.5, P = 0.024). A wider and shallower pelvis was less likely to result in a positive margin (odds ratio 0.25, 95% confidence interval [CI] 0.09–0.72). On multivariate analysis, urinary continence recovery was associated with surgeon's prior RARP experience (hazard ratio [HR] 2.38, 95% CI 1.18–4.81; P = 0.015), but not on pelvic dimensions (HR 1.44, 95% CI 0.95–2.17). Conclusion Limited surgical workspace, due to a narrower and deeper pelvis, does affect surgeon performance and patient outcomes, most notably in longer surgery time and an increased positive margin rate.