International expert consensus on metric-based characterization of robot-assisted total laparoscopic hysterectomy...

Area of Science:

• Surgical innovation and medical device development.
• Robotic surgery and minimally invasive procedures.
• Gynaecological surgery and patient outcomes.

Background:

• Robot-assisted total laparoscopic hysterectomy (RATLH) is increasingly utilized, necessitating standardized performance evaluation.
• Current assessment methods for RATLH lack comprehensive, validated procedural metrics.
• Establishing objective metrics is crucial for training, quality improvement, and surgical standardization.

Purpose of the Study:

• To develop standardized procedural performance metrics for RATLH.
• To establish face and content validity of these metrics through expert consensus.
• To create a foundation for future reliability and construct validity assessments.

Main Methods:

• A core metrics team conducted a detailed task deconstruction of the RATLH procedure.
• Two modified Delphi consensus meetings (face-to-face and online) were employed.
• Twenty-eight international RATLH experts participated in the consensus process.

Main Results:

• Initial metrics included 20 Phases, 110 Steps, 119 Errors, and 54 Critical Errors.
• Post-Delphi consensus resulted in 20 Phases, 116 Steps, 134 Errors, and 56 Critical Errors.
• 100% consensus was achieved on 41 general edits, validating the metrics.

Conclusions:

• This study provides the first comprehensive metric-based characterization of RATLH.
• Expert consensus validated a structured methodology for assessing Steps, Errors, and Critical Errors.
• Future research will focus on evaluating the reliability and construct validity of the developed metrics.