Video evaluation of robot-assisted partial nephrectomy may help assess surgical skill
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Key takeaways:
- Lower rates of adverse outcomes were linked to higher technical skill
- Surgeons with higher scores had lower rates of patients who had ED visits.
Video-based evaluation of robot-assisted partial nephrectomy may be an important step to assess surgical skill and improve patient care, according to recently published data.
“Surgical technical skills may be variable between surgeons and may influence intraoperative and postoperative outcomes,” Yuzhi Wang, MD, of the Vattikuti Urology Institute, Henry Ford Health in Detroit, wrote with colleagues. They added, “While robot-assisted partial nephrectomy is commonly performed, it is considered a technically challenging surgery, and potential complications include hemorrhage, urinary leakage, the need to convert to radical nephrectomy and/or open surgery, the failure to entirely remove cancer and other general postoperative complications. ... To date, there have been no studies that have assessed the technical quality of surgeons performing this surgery and its association with patient outcomes.”
Researchers performed a quality improvement test of 10 urological surgeons to assess if technical skill is connected to perioperative outcomes in robot-assisted kidney surgery.
Each surgeon presented seven videos exhibiting how they perform partial nephrectomy with robot assistance. The videos were cut into six key steps for a total 127 clips.
The clips were de-identified and distributed to at least three of the 24 masked peer surgeons who also perform partial nephrectomies. Reviewers rated clips using a validated instrument to assess technical skill on a 1-to-5 scale and provided written feedback.
Outcomes from a clinical registry were assessed for patients’ length of stay greater than 3 days, estimated blood loss greater than 500 mL, warm ischemia time greater than 30 minutes, positive surgical margin, 30-day ED visits and 30-day readmission.
Lower rates of adverse outcomes were linked to higher technical skill, according to the results. Surgeons with higher scores had lower rates of patients with extended hospital stays and reduced instances of patients with high estimated blood loss, as well as positive surgical margins, ED visits and readmissions within 30 days of the procedure.
Overall performance scores ranged from 3.5 to 4.7 points. The mean score was 4.1. Researchers found surgeons with higher annual partial nephrectomy volumes had more technical skill.
Greater technical skill was associated with lower rates of patients with a length of stay more than 3 days, estimated blood loss above 500 mL, ED stays and readmissions, according to the researchers, showing the importance of surgeon proficiency in positive outcomes.
“These findings suggest that video-based evaluation plays a role in assessing surgical skill and can be used in quality improvement initiatives to improve patient care,” they wrote. They added, “This evaluation modality may help surgeons improve their proficiency, which has implications toward better patient care and oncologic control.”
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