Outcome prediction in bariatric surgery through video-based assessment

Area of Science:

• Robotic surgery
• Surgical skill assessment
• Bariatric surgery outcomes

Background:

• The link between intraoperative robotic surgical performance and patient outcomes at a single-case level remains underexplored.
• The Global Evaluative Assessment of Robotic Skills (GEARS) score quantifies robotic surgical proficiency across five domains.
• Surgeon skill variability necessitates evaluating performance metrics at the individual patient level.

Purpose of the Study:

• To investigate if higher surgical skill, assessed by the GEARS score, predicts individual patient outcomes.
• To determine the correlation between GEARS scores and excess weight loss (EWL) and serious morbidity following robotic sleeve gastrectomy.

Main Methods:

• A prospective database of 162 patients undergoing robotic sleeve gastrectomy was analyzed.
• Statistical analyses included Pearson's correlation, ANOVA, chi-square tests, and multivariable linear regression.
• GEARS scores were correlated with EWL at 6 and 12 months and serious morbidity within 30 days.

Main Results:

• GEARS scores did not correlate with serious morbidity (p=0.914) but significantly predicted EWL at 6 months (p<0.001) and 12 months (p<0.001).
• All GEARS subcomponent scores (bimanual dexterity, depth perception, efficiency, force sensitivity, robotic control) predicted EWL at both 6 and 12 months.
• No significant correlation was found between initial GEARS scores and EWL at 6 or 12 months on unadjusted analysis.

Conclusions:

• Surgical skill, as measured by the GEARS score, is correlated with excess weight loss in patients undergoing robotic sleeve gastrectomy.
• Improved performance in robotic sleeve gastrectomy, indicated by higher GEARS scores, can lead to better postoperative weight loss outcomes.