Mp01-19 Exploring Technique of the Vesicourethral Anastomosis in Robotic-assisted Radical Prostatectomy With Automated and Manually Observed Metrics
Year: 2018
Type: article
Abstract: You have accessJournal of UrologySurgical Technology & Simulation: Training & Skills Assessment I1 Apr 2018MP01-19 EXPLORING TECHNIQUE OF THE VESICOURETHRAL ANASTOMOSIS IN ROBOTIC-ASSISTED RADICAL PROSTATECTOMY WITH AUTOMATED AND MANUALLY OBSERVED METRICS Jian Chen, Paul Oh, Nathan Cheng, Ankeet Shah, Liheng Guo, Anthony Jarc, and Andrew Hung Jian ChenJian Chen More articles by this author , Paul OhPaul Oh More articles by this author , Nathan ChengNathan Cheng More articles by this author , Ankeet ShahAnkeet Shah More articles by this author , Liheng GuoLiheng Guo More articles by this author , Anthony JarcAnthony Jarc More articles by this author , and Andrew HungAndrew Hung More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.125AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Vesicourethral anastomosis (VUA) is a critical and technically demanding step of the robotic-assisted radical prostatectomy. We evaluate the technique of robotic VUA through automated and manually observed metrics. METHODS Automated performance metrics (EndoWrist® instrument motion tracking and articulation data, and robotic events data) and synchronized surgical video were captured from da Vinci Si systems utilizing a novel recorder (dVLogger; Intuitive Surgical). On video review, needle-needle driver position, needle entry angle, tissue trauma, and suturing gestures were manually recorded. Automated metrics and manually recorded outcomes were compared between experts (≥100 console cases) and novices (<100 cases). Robotic suturing gestures were summarized and compared by the performance metrics, using a mixed effect model. RESULTS Seventy VUAs with 1,745 stitches were studied, representing 9 experts and 9 novices (all right-hand dominant). Experts outperformed novices in completion time (p<0.01) and dominant instrument path length (p<0.03) during ″Needle driving″ and ″Suture cinching″. During ″Needle driving″, experts had a wider range of instrument shaft rolling (p<0.01) and wrist articulation (p<0.03). Across the entire stitch, experts were more efficient with instrument movement (p<0.02) and camera manipulation (p<0.01). Fourteen common robotic VUA gestures were identified. Needle being driven using several different gestures without a discernable pattern was categorized as ″Random gestures.″ (Figure). Gestures utilized for each stitch were summarized and compared. Posterior bladder neck: Surgeons used forehand underhand consistently. Bilateral sides of bladder neck and urethral stump: Several different gestures were used (no significant difference in performance, p>0.05). Posterior anterolateral urethral wall: Random gestures were associated with less movement efficiency (p<0.01), less instrument articulation (p=0.05), more needle driving attempts (p<0.04) and more tissue trauma (p<0.01). CONCLUSIONS Experts were more efficient and flexible with instruments while performing robotic VUA. Organized suturing gesture patterns and technique were associated with more efficient movement and less tissue trauma. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e10 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Jian Chen More articles by this author Paul Oh More articles by this author Nathan Cheng More articles by this author Ankeet Shah More articles by this author Liheng Guo More articles by this author Anthony Jarc More articles by this author Andrew Hung More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
Source: The Journal of Urology
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2795645007