Machine learning analyses of automated performance metrics during granular sub-stitch phases predict surgeon...

Automated performance metrics objectively measure surgeon performance during a robot-assisted radical prostatectomy. Machine learning has demonstrated that automated performance metrics, especially during the vesico-urethral anastomosis of the robot-assisted radical prostatectomy, are predictive of long-term outcomes such as continence recovery time. This study focuses on automated performance metrics during the vesico-urethral anastomosis, specifically on stitch versus sub-stitch levels, to distinguish surgeon experience. During the vesico-urethral anastomosis, automated performance metrics, recorded by a systems data recorder (Intuitive Surgical, Sunnyvale, CA, USA), were reported for each overall stitch (C^total) and its individual components: needle handling/targeting (C¹), needle driving (C²), and suture cinching (C³) (Fig 1, A). These metrics were organized into three datasets (GlobalSet [whole stitch], RowSet [independent sub-stitches], and ColumnSet [associated sub-stitches] (Fig 1, B) and applied to three machine learning models (AdaBoost, gradient boosting, and random forest) to solve two classifications tasks: experts (≥100 cases) versus novices (<100 cases) and ordinary experts (≥100 and <2,000 cases) versus super experts (≥2,000 cases). Classification accuracy was determined using analysis of variance. Input features were evaluated through a Jaccard index. From 68 vesico-urethral anastomoses, we analyzed 1,570 stitches broken down into 4,708 sub-stitches. For both classification tasks, ColumnSet best distinguished experts (n = 8) versus novices (n = 9) and ordinary experts (n = 5) versus super experts (n = 3) at an accuracy of 0.774 and 0.844, respectively. Feature ranking highlighted Endowrist articulation and needle handling/targeting as most important in classification. Surgeon performance measured by automated performance metrics on a granular sub-stitch level more accurately distinguishes expertise when compared with summary automated performance metrics over whole stitches.