Objective Performance Indicators Differ Between Expert Versus Novice Surgeons During Robotic Proctectomy

Area of Science:

• Robotic surgery
• Surgical skill assessment
• Machine learning in medicine

Background:

• Objective performance indicators (OPIs) derived from robotic systems offer potential for evaluating surgical skill.
• Limited research exists on OPIs in colorectal surgery, specifically robotic proctectomy (RP).

Purpose of the Study:

• To identify specific OPIs that differentiate expert and novice surgeons during robotic proctectomy.
• To establish objective metrics for surgical skill in RP.

Main Methods:

• Analysis of synchronized endoscopic videos and robotic system data from 30 robotic proctectomies.
• Comparison of 541 critical surgical steps across 2 expert and 11 novice surgeons.
• Evaluation of OPIs including camera and arm movements, instrument handling, and energy application.

Main Results:

• Significant differences in OPIs were observed between expert and novice surgeons across all analyzed steps.
• Experts demonstrated distinct movement patterns, including greater velocity/acceleration, fewer arm swaps, and optimized instrument usage.
• Specific OPIs like wrist articulation and path length varied significantly with expertise during key dissection phases.

Conclusions:

• Step-specific OPIs effectively distinguish between expert and novice surgeons in robotic proctectomy.
• Validated OPIs can serve as objective tools for performance benchmarking, surgical training, and credentialing.