Effect of surgeon experience and bony pelvic dimensions on surgical performance and patient outcomes in robot-assisted radical prostatectomy

BJU Int. 2019 Nov;124(5):828-835. doi: 10.1111/bju.14857. Epub 2019 Jul 22.

Abstract

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 (APMs [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 APMs 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 APMs (P < 0.044), the patient's body mass index, bony pelvic dimensions, and prostate size also affected APMs 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.

Keywords: #PCSM; #ProstateCancer; pelvis; prostatectomy; robotic surgical procedures; urinary incontinence.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Humans
  • Male
  • Middle Aged
  • Pelvis / diagnostic imaging
  • Pelvis / surgery
  • Postoperative Complications
  • Prospective Studies
  • Prostate / diagnostic imaging
  • Prostate / surgery
  • Prostatectomy* / adverse effects
  • Prostatectomy* / methods
  • Prostatectomy* / statistics & numerical data
  • Prostatic Neoplasms / diagnostic imaging
  • Prostatic Neoplasms / surgery*
  • Robotic Surgical Procedures* / adverse effects
  • Robotic Surgical Procedures* / methods
  • Robotic Surgical Procedures* / statistics & numerical data
  • Surgeons / statistics & numerical data*
  • Treatment Outcome
  • Urinary Incontinence