Objective performance indicators during robotic Roux-en-Y gastric bypass distinguish experienced from trainee surgeons: a cross-sectional study

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Abstract
Introduction: Objective performance indicators (OPIs) obtained during robotic surgery have been associated with surgeons’ experience and may influence patient outcomes. However, their evaluation in bariatric surgery has received little attention. The study aimed to evaluate whether OPIs can effectively distinguish experienced surgeons from trainees during robotic Roux-en-Y gastric bypass (r-RYGB). Methods: Kinematic and event data were recorded during r-RYGB operations (n = 31; 2 experienced attending surgeons, 6 trainees) utilizing the da Vinci Surgical System’s data recorder between August 2021 and December 2022. De-identified data were extracted, videos annotated within eight surgical steps, and OPI generated and analyzed. OPIs generated included console active time, instrument movement speed (path length/console active time), bimanual dexterity (ratio of dominant to non-dominant instrument path length), and workspace volume rate. Results: Significant OPI differences were noted in 3 out of 8 steps of the procedure. During the dissection phase, attending surgeons exhibited greater right-hand controller usage (bimanual dexterity, p = 0.018), and faster non-dominant instrument path length speed (p = 0.002). During the creation of the gastric pouch, experts displayed similar higher bimanual dexterity (p = 0.001), but slower non-dominant instrument path length speed (p = 0.012). Trainees had a lower active console time than attending surgeons during gastric pouch creation (p = 0.03) and hand-sewn anastomosis (p = 0.005). Both cohorts demonstrated similar OPIs during other steps such as mesenteric division, mesenteric closure, common channel enterotomy closure, limb measurement, and stapled anastomosis. Conclusion: Step-specific OPIs obtained during robotic surgery can effectively distinguish between experienced and trainee surgeons. With further validation, OPIs may provide an objective assessment of trainee performance and aid in training and autonomy decisions.

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