MyIntuitive telemetry identifies proficiency thresholds in robotic pancreaticoduodenectomy

Area of Science:

• Robotic Surgery
• Surgical Education
• Medical Device Technology

Background:

• Quantifying surgical learning curves in robotic pancreaticoduodenectomy (RPD) is difficult due to case selection and conversions.
• MyIntuitive intraoperative telemetry offers objective, process-level data to assess proficiency gains.
• Traditional metrics can be confounded by factors unrelated to surgeon skill.

Purpose of the Study:

• To evaluate the utility of MyIntuitive telemetry for quantifying the learning curve in RPD.
• To identify a proficiency threshold using telemetry data and statistical modeling.
• To correlate telemetry findings with robotic completion rates and conversion patterns.

Main Methods:

• Analysis of 100 consecutive RPD cases performed by a single surgeon using MyIntuitive telemetry.
• Primary outcome: Full-Case idle time; secondary outcomes: console time, active time, instrument exchanges.
• Risk-adjusted cumulative sum (RA-CUSUM) and logistic regression used to model robotic completion probability and identify proficiency inflection points.

Main Results:

• Significant reductions in idle time (42 to 32 min), console time (470 to 395 min), and active time (428 to 365 min) were observed.
• A proficiency inflection point for idle time was identified around cases 50-60.
• Robotic completion rate improved from 76.7% to 92.5% after case 60, with a significant decrease in overall conversion rate (P=0.033).

Conclusions:

• MyIntuitive idle time serves as a sensitive, telemetry-based endpoint for tracking the RPD learning curve.
• The study identified a proficiency threshold around 60 cases, corroborated by intention-to-treat completion trends.
• This telemetry-first approach offers objective insights for coaching and optimizing complex robotic pancreatic surgery programs.