European expert consensus on a structured approach to training robotic‐assisted low anterior resection using performance metrics

Abstract

Aim The aim was to develop and operationally define 'performance metrics' that characterize a reference approach to robotic-assisted low anterior resection (RA-LAR) and to obtain face and content validity through a consensus meeting. Method Three senior colorectal surgeons with robotic experience and a senior behavioural scientist formed the Metrics Group. We used published guidelines, training materials, manufacturers' instructions and unedited videos of RA-LAR to deconstruct the operation into defined, measurable componentsperformance metrics (i.e. procedure phases, steps, errors and critical errors). The performance metrics were then subjected to detailed critique by 18 expert colorectal surgeons in a modified Delphi process. Results Performance metrics for RA-LAR had 15 procedure phases, 128 steps, 89 errors and 117 critical errors in women, 88 errors and 118 critical errors in men. After the modified Delphi process the final performance metrics consisted of 14 procedure phases, 129 steps, 88 errors and 115 critical errors in women, 87 errors and 116 critical errors in men. After discussion by the Delphi panel, all procedure phases received unanimous consensus apart from phase I (patient positioning and preparation, 83%) and phase IV (docking, 94%). Conclusion A robotic rectal operation can be broken down into procedure phases, steps, with errors and critical errors, known as performance metrics. The face and content of these metrics have been validated by a large group of expert robotic colorectal surgeons from Europe. We consider the metrics essential for the development of a structured training curriculum and standardized procedural assessment for RA-LAR.

Intraoperative robotic-assisted low anterior rectal resection performance assessment using procedure-specific binary metrics and a global rating scale

“…A prospective study of video analysis of RA-LAR was carried out using the parameters previously published 4 .…”

“…The development of the PBP that characterizes a ‘reference’ approach to RA-LAR was described previously 4 . In brief, the RA-LAR was characterized by the metrics team and verified by a Delphi panel.…”

“…An example of one of the procedure phases is shown in Fig. S1 4 . These procedure phases, steps, errors, and critical errors are well defined, unambiguous, and either occurred or did not occur (binary).…”

“…It is, therefore, vital to identify objective, transparent, evidence-based tools to enhance training and assessment. One of these methods is proficient-based progressive (PBP) training 4 . In prospective, randomized clinical trials in different specialties, the PBP method was shown to produce skillsets that are 40–60 per cent superior to traditional training approaches 5–14 and had a positive impact on clinical outcomes 15 .…”

“…One of the remits of the ESC is to improve training and clinical outcomes of patients from robotic-assisted (RA) LAR. The PBP metric was previously applied to RA-LAR and obtained face and content validations 4 . RA-LAR was deconstructed to smaller components—procedural phases with steps, to recognize errors and critical errors, with distinction between sexes.…”