TECHNICAL PERFORMANCE
Quantifying the "Assistant Effect" in Robotic-Assisted Radical Prostatectomy
Published on
December 25, 2021
Journal of Surgical Research
Overview
This study aimed to assess the association between a bedside assistant's technical skill and surgeon performance in Robotic-Assisted Radical Prostatectomy (RARP). Using prospective intraoperative video from 92 RARP cases across three centers, the research team analyzed the dissection of the prostatic pedicle and neurovascular bundle step. Expert analysts scored console surgeon performance using the Global Evaluative Assessment of Robotic Skills (GEARS) and bedside assistant performance using a modified Objective Structured Assessment of Technical Skills (aOSATS).
The results showed a weak but significant correlation between assistant aOSATS scores and surgeon GEARS scores during the neurovascular bundle step. Assistant skill level was significantly associated with robotic console experience and prior laparoscopic experience. Linear regression analysis confirmed that aOSATS remained a significant predictor of console surgeon performance, even after controlling for various patient factors. This study is the first to demonstrate an association between assistant technical skill and surgeon performance in RARP, and it provides validity evidence for a modified OSATS global rating scale for training and assessing bedside assistant performance in robotic surgery.
Results
92 RARP cases were available for the analysis, comprising 14 console surgeons and 22 different bedside assistants. In only 5 (5.4%) cases, the neurovascular bundle step was completed by a trainee, and in 13 (14.1%) of cases, a staff-level surgeon acted as the bedside assistant. aOSATS score was significantly associated with robotic console experience (P = 0.011), and prior laparoscopic experience (P < 0.001). Assistant aOSATS score showed a weak but significant correlation with surgeon GEARS score during the neurovascular bundle step (spearman's rho = 0.248, P = 0.028). On linear regression, aOSATS remained a significant predictor of console surgeon performance (P = 0.016), after controlling for patient age and BMI, prostate volume, tumor stage, and presence of nerve-sparing.
