Mp11-03 Modular Training for Rarp: Where to Begin?

Abstract

INTRODUCTION AND OBJECTIVES: Flow disruptions (FD) are deviations from the natural progression of a procedure which potentially compromise the efficiency and safety of the operation. Although a single FD will likely result in little to no consequence on the outcome of an operation, the accumulation of FD has empirically been linked to a higher prevalence of surgical errors. In surgery, they can occur every 5-10 minutes, reduce efficiency, lead to more serious problems, and indicate where the systems of care are failing to deliver the best performance. We sought to determine the impact of resident training on FD and its effect on operative time.METHODS: This was a prospective observational study of a total of 35 robotic urologic and gynecologic surgeries performed at a single teaching institution. Eighteen of the 35 cases had resident participation. Flow disruptions were noted by previously trained observers and sorted into the following categories: disruptions in communication, coordination, external factors, equipment, environment, and patient factors. The number of FD and rate of FD per hour in cases with resident involvement was compared to that of non-resident group. RESULTS: Mean operating room time for robotic cases with resident involvement was 5.9 hours compared to 4.5 hours in nonteaching cases. Mean number of FD observed in teaching cases (n¼67) was significantly greater than of non-teaching cases (n¼33), p<0.001. Table 1 shows the difference in FD per category for teaching vs non-teaching cases. The mean FD/hr rate for teaching cases was 11.7 per hour compared to 7.3 per hour for non-teaching cases (p<0.001). FD overall contributed to 11.8% of total OR time and contributed to an additional 25 min per non-teaching case and 48 min per teaching case. The most common FD were coordination and equipment disruptions, contributing to almost 60% of all FD observed.CONCLUSIONS: The increase in FD with resident involvement demonstrates the multifaceted nature of training in robotic surgery. Many factors other than surgical technique on the robotic console play a role in the learning curve for robotics. Our study suggests that teaching cases had more FD and led to increased operative times. To improve efficiency and safety in robotic surgery, further research is needed to find ways to minimize FD such as development of checklists, teamwork training, and new equipment designs.

Measures of performance and proficiency in robotic assisted surgery: a systematic review

“…Of all the metrics identified in this review; the majority were specific to urology; the Prostatectomy Assessment Competency Evaluation (PACE) score, Robotic Assessment Radical Prostatectomy (RARP) score and the Cystectomy Assessment and Surgical Evaluation (CASE) score [39][40][41]. However, these metrics relied upon subjective measures of assessment.…”

“…The RARP score [40] and the Prostatectomy Assessment and Competency Evaluation (PACE) [39] both deconstruct a RARP procedure into key stages. Both scores had content validity, however, although there were fewer participants in the RARP score study it was used across a larger number of RARP videos (n=428).…”