Journal Article Ahead of print
PubMed: 42902911 DOI: 10.1111/bju.70503
Intraoperative performance errors predict patient outcomes in robot-assisted radical prostatectomy.
BJU Int
Authors: Markus Graefen, Peter Wiklund, Claudio Brancelli, Brendan P Bunting, Alberto Breda, Niki Rashidian, Edoardo Beatrici, Ruben De Groote, Rui Farinha, Anne Sophie Knipper, Maria Peraire Lores, Stefano Puliatti, Marco Amato, Camille Berquin, Burkhard Beyer, Carlo Andrea Bravi, Jan Hohenhorst, Elio Mazzone, Marco Paciotti, Artur Paludo, Pietro Piazza, Luca Sarchi, Anthony G Gallagher, Alexandre Mottrie
Affiliations
- Martini-Klinik, Prostate Cancer Center at the University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
- Department of Molecular Medicine and Surgery Section of Urology, Karolinska Institutet, Stockholm, Sweden.
- ORSI Academy, Melle, Belgium.
- Department of Urology, OLV, Aalst, Belgium.
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy.
- School of Psychology, Ulster University, Derry, UK.
- Fundació Puigvert, Uro-Oncology Unit and Kidney Transplant Surgical Program, Barcelona, Spain.
- ERUS-EAU, Barcelona, Spain.
- Department of Urology, Hospital da Luz, Lisbon, Portugal.
- Vivantes Klinikum Am Urban, Berlin-Kreuzberg, Germany.
- Urology Department, Joan XXIII University Hospital, Tarragona, Spain.
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy.
- Urology Department, University of Gent, Ghent, Belgium.
- Kliniken Hartenstein, Bad Wildungen, Germany.
- Asst Grande Ospedale Metropolitano Niguarda, Milan, Italy.
- Humanitas University, Milan, Italy.
- Uro-Oncology and Robotics, Hospital Moinhos de Vento, Porto Alegre, Brazil.
- Urology, IRCCS Policlinico di Sant'Orsola, Bologna, Italy.
- Faculty of Medicine, KU Leuven, Leuven, Belgium.
- Faculty of Life and Health Sciences, School of Medicine, Ulster University, Londonderry, UK.
Abstract
OBJECTIVES
To evaluate the association between objectively assessed intraoperative surgical performance and postoperative functional outcomes following robot-assisted radical prostatectomy (RARP).
PATIENTS/SUBJECTS AND METHODS
Prospectively collected data from 100 patients undergoing bilateral nerve-sparing RARP by seven experienced robotic surgeons were analysed. To control for age-related confounding, a subgroup of 66 subjects was selected from the initial cohort using age-matching. These patients, all of whom were preoperatively potent, were identified from an audited outcomes registry with complete video recordings. In all, 14 trained surgeons trained to score the recordings using validated RARP-specific metrics for procedure steps, errors, critical errors, and nerve-sparing phase errors.
RESULTS
There were no significant pre- or postoperative differences in demographic or clinical variables between patients with good or poor outcomes. The mean inter-rater reliability of video assessments was high (0.91). There were no significant differences in the number of steps completed or critical errors made. Intraoperative performance in cases resulting in erectile dysfunction at 12 months was characterised by 43% more total errors and 67% more neurovascular bundle (NVB) dissection errors (P < 0.001) compared to cases with good functional outcomes. Age-matched analysis confirmed differences of 31-54% (P < 0.001). The number of intraoperative errors, particularly during NVB dissection, was strongly associated with clinical outcomes (P = 0.01-0.008).
CONCLUSIONS
The objectively assessed intraoperative performance of the surgeon strongly predicted the clinical outcome of the procedure at 1 year. The more errors the surgeon made the more likely the patient was to have erectile dysfunction at 12 months.
MeSH
Erectile Dysfunction, Prostatic Neoplasms, Prostatectomy, Dissection, Surgeons