Training Feedback Tailored to Technical Skills Expedites Proficiency in Performing Watertight Vesicourethral...

The vesicourethral anastomosis (VUA) is a technically demanding step during the robot-assisted radical prostatectomy (RARP), requiring a watertight seal to prevent postoperative urine leak. Our randomized controlled trial evaluated suturing skills critical to successful VUAs and assessed whether tailored feedback focusing on deficient skills expedites their proper execution.

Nineteen residents completed weekly simulated robot-assisted VUAs on silicone bladder-urethra models for 10 weeks, with a follow-up session after 3 to 4 weeks. All received standardized basic training and completed baseline sessions. We evaluated technical performance using our previously validated End-to-End Assessment of Suturing Expertise (EASE) tool. Participants were randomized into 3 feedback groups: (1) Control (training video), (2) Conventional (training video + EASE scoring criteria + video recordings of their own previous sessions), and (3) Tailored (all Conventional resources + feedback on key deficient skills).

We had 17 of 19 participants complete all 10 sessions (n = 170). All 7 participants in the Tailored group achieved and sustained watertight VUAs, compared to only 1 of 6 in the Conventional and 0 of 5 in the Control groups (p < 0.001). Suturing skill metrics predicted watertightness with 78% sensitivity (95% confidence interval 0.70-0.86) and 72% specificity (95% confidence interval 0.61-0.82). The top 5 suturing skills predicting a watertight VUA included Needle Hold Angle, Depth of Needle Hold, Needle Repositions, Wrist Rotation during Needle Withdrawal, and Needle Driving Smoothness. The Tailored group retained their performance at the follow-up session, 3 to 4 weeks later.

Tailored feedback targeting deficient skills significantly expedites achieving VUA watertightness, and surgical skills quantified by the EASE tool can predict a successful VUA.