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Surgeon Performance Predicts Early Continence After Robot-Assisted Radical Prostatectomy.
J Endourol. 2017 09; 31(9):858-863.JE

Abstract

INTRODUCTION

There is limited, yet compelling evidence supporting the role of surgeon technical performance in influencing patient outcomes. To date, this concept has been underexplored in endourologic procedures. We hypothesized that a surgeon's technical performance plays a role in predicting an early return to continence after robot-assisted radical prostatectomy (RARP).

MATERIALS AND METHODS

We conducted a retrospective, matched case-control analysis of prospectively collected unedited RARP endoscopic videos performed by a single surgeon. A blinded observer with expertise in intraoperative video analysis evaluated clinically relevant steps of RARP using the global evaluative assessment of robotic skill (GEARS) and the generic error rating tool (GERT). The primary outcome was continence status at 3 months postoperatively, defined as patient use of less than or equal to a single precautionary pad. Mann-Whitney U tests examined differences in predictor variables between cases and controls, and multivariate analysis was conducted using binary logistic regression models.

RESULTS

Twenty-four incontinent patients were matched for age, body mass index, preoperative International Prostate Symptoms Score, use of posterior/anterior hitch, prostate weight, and learning curve position. No statistically significant difference in errors between groups was observed using the GERT. On multivariate analysis, overall case GEARS score was independently predictive of 3-month continence status (odds ratios [OR] = 0.55, 95% confidence interval [CI] 0.33-0.91), as were urethrovesical anastomosis (OR = 0.70, 95% CI 0.50-0.97) and bladder neck GEARS scores (OR = 0.69, 95% CI 0.51-0.94).

CONCLUSIONS

Our study generates the hypothesis that there may be a link between surgeon technical performance and functional outcomes in RARP. This relationship may have implications for the accreditation and training of future urologists and warrants further investigation.

Authors+Show Affiliations

1 Division of Urology, University of Toronto , Toronto, Canada . 2 Department of Urologic Sciences, University of British Columbia , Vancouver, Canada .3 Department of Surgery, University of Toronto , Toronto, Canada .2 Department of Urologic Sciences, University of British Columbia , Vancouver, Canada .

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28557582

Citation

Goldenberg, Mitchell G., et al. "Surgeon Performance Predicts Early Continence After Robot-Assisted Radical Prostatectomy." Journal of Endourology, vol. 31, no. 9, 2017, pp. 858-863.
Goldenberg MG, Goldenberg L, Grantcharov TP. Surgeon Performance Predicts Early Continence After Robot-Assisted Radical Prostatectomy. J Endourol. 2017;31(9):858-863.
Goldenberg, M. G., Goldenberg, L., & Grantcharov, T. P. (2017). Surgeon Performance Predicts Early Continence After Robot-Assisted Radical Prostatectomy. Journal of Endourology, 31(9), 858-863. https://doi.org/10.1089/end.2017.0284
Goldenberg MG, Goldenberg L, Grantcharov TP. Surgeon Performance Predicts Early Continence After Robot-Assisted Radical Prostatectomy. J Endourol. 2017;31(9):858-863. PubMed PMID: 28557582.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgeon Performance Predicts Early Continence After Robot-Assisted Radical Prostatectomy. AU - Goldenberg,Mitchell G, AU - Goldenberg,Larry, AU - Grantcharov,Teodor P, Y1 - 2017/06/26/ PY - 2017/5/31/pubmed PY - 2018/5/11/medline PY - 2017/5/31/entrez KW - medical errors KW - prostatectomy KW - psychomotor performance KW - robotic surgical procedures KW - urinary incontinence SP - 858 EP - 863 JF - Journal of endourology JO - J. Endourol. VL - 31 IS - 9 N2 - INTRODUCTION: There is limited, yet compelling evidence supporting the role of surgeon technical performance in influencing patient outcomes. To date, this concept has been underexplored in endourologic procedures. We hypothesized that a surgeon's technical performance plays a role in predicting an early return to continence after robot-assisted radical prostatectomy (RARP). MATERIALS AND METHODS: We conducted a retrospective, matched case-control analysis of prospectively collected unedited RARP endoscopic videos performed by a single surgeon. A blinded observer with expertise in intraoperative video analysis evaluated clinically relevant steps of RARP using the global evaluative assessment of robotic skill (GEARS) and the generic error rating tool (GERT). The primary outcome was continence status at 3 months postoperatively, defined as patient use of less than or equal to a single precautionary pad. Mann-Whitney U tests examined differences in predictor variables between cases and controls, and multivariate analysis was conducted using binary logistic regression models. RESULTS: Twenty-four incontinent patients were matched for age, body mass index, preoperative International Prostate Symptoms Score, use of posterior/anterior hitch, prostate weight, and learning curve position. No statistically significant difference in errors between groups was observed using the GERT. On multivariate analysis, overall case GEARS score was independently predictive of 3-month continence status (odds ratios [OR] = 0.55, 95% confidence interval [CI] 0.33-0.91), as were urethrovesical anastomosis (OR = 0.70, 95% CI 0.50-0.97) and bladder neck GEARS scores (OR = 0.69, 95% CI 0.51-0.94). CONCLUSIONS: Our study generates the hypothesis that there may be a link between surgeon technical performance and functional outcomes in RARP. This relationship may have implications for the accreditation and training of future urologists and warrants further investigation. SN - 1557-900X UR - https://www.unboundmedicine.com/medline/citation/28557582/Surgeon_Performance_Predicts_Early_Continence_After_Robot_Assisted_Radical_Prostatectomy_ L2 - https://www.liebertpub.com/doi/full/10.1089/end.2017.0284?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -