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Using video review to understand the technical variation of robot-assisted radical prostatectomy in a statewide surgical collaborative.

Abstract

PURPOSE

Video assessment is an emerging tool for understanding surgical technique. Patient outcomes after robot-assisted radical prostatectomy (RARP) may be linked to technical aspects of the procedure. In an effort to refine surgical approaches and improve outcomes, we sought to understand technical variation for the key steps of RARP in a surgical collaborative.

METHODS

The Michigan Urological Surgery Improvement Collaborative (MUSIC) is a statewide quality improvement collaborative with the aim of improving prostate cancer care. MUSIC surgeons were invited to submit representative complete videos of nerve-sparing RARP for blinded analysis. We also analyzed peri-operative outcomes from these surgeons in the registry.

RESULTS

Surgical video data from 20 unique surgeons identified many variations in technique and time to complete different steps. Common to all surgeons was a transperitoneal approach and a running urethrovesical anastomosis. Prior to anastomosis, 25% surgeons undertook a posterior reconstruction and 30% employed urethral suspension. 65% surgeons approached the seminal vesicle anteriorly. For control of the dorsal vein complex, suture ligation was used in 60%, and vascular stapler was 15%. The majority (80%) of surgeons employed clips for managing pedicles. In examining patient outcomes for surgeons, peri-operative outcomes were not correlated with surgeon's operative time; however, surgeons with an EBL > 400 ml had significant difference among the five different techniques employed.

CONCLUSIONS

Despite the worldwide popularity of RARP, the operation is still far from standardized. Correlating variation in technique with clinical outcomes may help provide objective data to support best practices with the goal to improve patient outcomes.

Authors+Show Affiliations

Department of Urology, University of Michigan, North Campus Research Complex Building 16, 114W, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA. Department of Urology, E-Da Hospital, Kaohsiung, Taiwan.School of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.Department of Urology, Detroit Medical Center, Detroit, MI, USA.Department of Urology, University of Michigan, North Campus Research Complex Building 16, 114W, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA.Department of Urology, University of Michigan, North Campus Research Complex Building 16, 114W, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA.Department of Urology, University of Michigan, North Campus Research Complex Building 16, 114W, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA.Department of Urology, University of Michigan, North Campus Research Complex Building 16, 114W, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA.IHA-Urology, St. Joseph Healthcare, Ypsilanti, MI, USA.Department of Urology, University of Michigan, North Campus Research Complex Building 16, 114W, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA.Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.Department of Urology, University of Michigan, North Campus Research Complex Building 16, 114W, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA. kghani@med.umich.edu.Oakland University/Beaumont School of Medicine, Auburn Hills, MI, USA.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31444604

Citation

Wu, Richard C., et al. "Using Video Review to Understand the Technical Variation of Robot-assisted Radical Prostatectomy in a Statewide Surgical Collaborative." World Journal of Urology, 2019.
Wu RC, Prebay ZJ, Patel P, et al. Using video review to understand the technical variation of robot-assisted radical prostatectomy in a statewide surgical collaborative. World J Urol. 2019.
Wu, R. C., Prebay, Z. J., Patel, P., Kim, T., Qi, J., Telang, J., ... Johnston, W. K. (2019). Using video review to understand the technical variation of robot-assisted radical prostatectomy in a statewide surgical collaborative. World Journal of Urology, doi:10.1007/s00345-019-02906-4.
Wu RC, et al. Using Video Review to Understand the Technical Variation of Robot-assisted Radical Prostatectomy in a Statewide Surgical Collaborative. World J Urol. 2019 Aug 23; PubMed PMID: 31444604.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Using video review to understand the technical variation of robot-assisted radical prostatectomy in a statewide surgical collaborative. AU - Wu,Richard C, AU - Prebay,Zachary J, AU - Patel,Parin, AU - Kim,Tae, AU - Qi,Ji, AU - Telang,Jaya, AU - Linsell,Susan, AU - Kleer,Eduardo, AU - Miller,David C, AU - Peabody,James O, AU - Ghani,Khurshid R, AU - Johnston,William K,3rd AU - ,, Y1 - 2019/08/23/ PY - 2019/04/23/received PY - 2019/08/09/accepted PY - 2019/8/25/entrez KW - Prostate cancer KW - Radical prostatectomy KW - Robotic surgery KW - Technique KW - Video assessment JF - World journal of urology JO - World J Urol N2 - PURPOSE: Video assessment is an emerging tool for understanding surgical technique. Patient outcomes after robot-assisted radical prostatectomy (RARP) may be linked to technical aspects of the procedure. In an effort to refine surgical approaches and improve outcomes, we sought to understand technical variation for the key steps of RARP in a surgical collaborative. METHODS: The Michigan Urological Surgery Improvement Collaborative (MUSIC) is a statewide quality improvement collaborative with the aim of improving prostate cancer care. MUSIC surgeons were invited to submit representative complete videos of nerve-sparing RARP for blinded analysis. We also analyzed peri-operative outcomes from these surgeons in the registry. RESULTS: Surgical video data from 20 unique surgeons identified many variations in technique and time to complete different steps. Common to all surgeons was a transperitoneal approach and a running urethrovesical anastomosis. Prior to anastomosis, 25% surgeons undertook a posterior reconstruction and 30% employed urethral suspension. 65% surgeons approached the seminal vesicle anteriorly. For control of the dorsal vein complex, suture ligation was used in 60%, and vascular stapler was 15%. The majority (80%) of surgeons employed clips for managing pedicles. In examining patient outcomes for surgeons, peri-operative outcomes were not correlated with surgeon's operative time; however, surgeons with an EBL > 400 ml had significant difference among the five different techniques employed. CONCLUSIONS: Despite the worldwide popularity of RARP, the operation is still far from standardized. Correlating variation in technique with clinical outcomes may help provide objective data to support best practices with the goal to improve patient outcomes. SN - 1433-8726 UR - https://www.unboundmedicine.com/medline/citation/31444604/Using_video_review_to_understand_the_technical_variation_of_robot-assisted_radical_prostatectomy_in_a_statewide_surgical_collaborative L2 - https://dx.doi.org/10.1007/s00345-019-02906-4 DB - PRIME DP - Unbound Medicine ER -