Using video analysis to understand the technical variation of robot-assisted radical prostatectomy (RARP) in a statewide surgical collaborative

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy V1 Apr 2018PD38-11 USING VIDEO ANALYSIS TO UNDERSTAND THE TECHNICAL VARIATION OF ROBOT-ASSISTED RADICAL PROSTATECTOMY (RARP) IN A STATEWIDE SURGICAL COLLABORATIVE Parin Patel, Tae Kim, Zack Prebay, Jaya Telang, Susan Linsell, Eduardo Kleer, David Miller, James O. Peabody, Khurshid R. Ghani, and William K. Johnston III Parin PatelParin Patel More articles by this author , Tae KimTae Kim More articles by this author , Zack PrebayZack Prebay More articles by this author , Jaya TelangJaya Telang More articles by this author , Susan LinsellSusan Linsell More articles by this author , Eduardo KleerEduardo Kleer More articles by this author , David MillerDavid Miller More articles by this author , James O. PeabodyJames O. Peabody More articles by this author , Khurshid R. GhaniKhurshid R. Ghani More articles by this author , and William K. Johnston IIIWilliam K. Johnston III More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1758AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Video assessment is an emerging tool for understanding variation in surgical technique. Despite its widespread adoption, patient outcomes for 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 statewide collaborative. METHODS The Michigan Urological Surgery Improvement Collaborative (MUSIC) is a statewide quality improvement collaborative consisting of 260 urologists from 44 diverse community and academic practices, with the aim of improving prostate cancer care. Representative complete videos of nerve-sparing RARP were voluntarily submitted to the MUSIC coordinating center. The duration and variations in the tasks performed during each part were captured. RESULTS The anterior approach was used by 65% of surgeons (vs posterior) for the seminal vesicle (SV) dissection. Captured video analysis data identified variation in time to complete different steps (Figure 1): bladder takedown (2-24 mins), endopelvic fascia dissection (4-11 mins), dorsal venous complex (DVC) control (2-10 mins), bladder neck dissection (7-30 mins), SV dissection (9-32 mins), nerve-sparing/pedicle control (8-33 mins), apical dissection (4-17 mins), and anastomosis (17-44 mins). Seven different permutations involving suture, staples and electrocautery for dividing/controlling the DVC were used. Management of the pedicle/nerve-sparing was performed using hem-o-lok clips (15), Enseal tissue sealer (4), and titanium clips (1). Prior to anastomosis, only 5/20 undertook a posterior reconstruction. A non-barbed (vs barbed) running suture (12/20) was the predominant anastomosis method and 6/20 placed a urethral suspension stitch. At the end, 50% of surgeons performed a bladder leak test with 11/20 surgeons placing drains regardless of the result. Two surgeons utilized SP tubes for bladder drainage. CONCLUSIONS RARP technique is not uniform. Video analysis identified variation in (1) time to complete each step (2) methods for DVC control, (3) nerve-sparing technique, and (4) performance of the urethrovesical anastomosis. Future efforts linking differences in technique with clinical outcomes can provide objective evidence to support best practices. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e740-e741 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Parin Patel More articles by this author Tae Kim More articles by this author Zack Prebay More articles by this author Jaya Telang More articles by this author Susan Linsell More articles by this author Eduardo Kleer More articles by this author David Miller More articles by this author James O. Peabody More articles by this author Khurshid R. Ghani More articles by this author William K. Johnston III More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...