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International expert consensus on metric-based characterization of robot-assisted total laparoscopic hysterectomy
Margarita Afonina1,2,3, Arnold Advincula4, Martin Martino5
1Orsi Academy, Melle, Belgium. afoninamargarita@hotmail.com.
Study Objective:
The study aimed to develop procedural performance metrics for robot-assisted total laparoscopic hysterectomy (RATLH) and to establish face and content validity through a Delphi consensus meeting.
Design:
A core metrics team comprising three highly experienced gynaecologists in RATLH and a behavioural scientist developed the metrics.
Setting:
Two modified Delphi consensus meetings took place as a face-to-face and online.
Patients:
The final metrics were discussed by 28 experts in RATLH from 13 different countries.
Interventions:
The core metrics team performed a detailed task deconstruction of the RATLH procedure. To ensure a comprehensive representation of technique and clinical practice across both the US and Europe, a consensus meeting was also conducted with European clinicians.
Measurements And Main Results:
Initially, performance metrics consisting of 20 Phases, 110 steps, 119 errors, and 54 critical errors were identified to characterize the RATLH procedure. During the Delphi meetings, these were discussed and modified. The outcome of the meeting was consensus on 20 Phases of the procedure, with 116 Steps (8 added, 2 deleted), 134 Errors (19 were added and 4 were deleted), and 56 Critical Errors (2 added). A total number of 41 general edits were performed with 100% consensus.
Conclusions:
This study presents the first comprehensive metric-based characterization of a standardized approach to RATLH, validated by expert consensus using a structured methodology that comprises operative procedure Steps, Errors, and Critical Errors. The next phase will evaluate reliability and the construct validity of the agreed metrics.
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