Objective performance indicators differ in obese and nonobese patients during robotic proctectomy.

Area of Science:

• Minimally Invasive Surgery
• Surgical Robotics
• Data Analytics in Surgery

Background:

• Obesity presents unique challenges in robotic surgery, potentially increasing complexity.
• Objective performance indicators (OPIs) offer quantifiable data on surgeon technique and robotic arm motion.
• This study investigates OPIs in robotic proctectomy comparing obese and nonobese patients.

Purpose of the Study:

• To identify and analyze differences in objective performance indicators during robotic proctectomy between obese and nonobese patient cohorts.
• To provide objective, data-driven insights into surgical performance variations based on patient BMI.

Main Methods:

• Analysis of endoscopic videos from 39 robotic proctectomies (13 obese, 26 nonobese).
• Annotation of 1880 surgical steps, focusing on splenic flexure mobilization, left colon mobilization, pelvic dissection, and rectal transection.
• Quantification of OPIs including arm swaps, path lengths, velocities, and energy activation times.

Main Results:

• Obese patients exhibited increased arm swaps and longer camera path lengths during splenic flexure mobilization.
• Left colon mobilization showed longer step times, more arm swaps, and increased camera/arm metrics in obese patients.
• Pelvic dissection and rectal transection steps also revealed significant differences in OPIs, such as energy activation time and camera movements, in obese individuals.

Conclusions:

• Step-specific objective performance indicators differ significantly between obese and nonobese patients undergoing robotic proctectomy.
• This study is the first to correlate patient attributes with surgeon movements and robotic kinematics using OPIs in robotic colorectal surgery.
• Objective metrics can enhance understanding and potentially optimize surgical training and technique for diverse patient populations.