Wendy S. Li

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.

Objective: Individuals with obesity face unique challenges when visiting healthcare providers, including inadequate equipment. These negative care experiences, often exacerbated by weight stigma, frequently lead to mistrust and reluctance to seek future care. Currently, few instruments exist to ensure that an ambulatory clinic is welcoming to patients with obesity. The following clinical environment checklist was created with an aim to identify weaknesses in accommodating individuals of size.Methods: A checklist of equipment considered ideal for the care of patients with obesity was developed through a comprehensive review of the literature and feedback from office staff. Eight ambulatory clinics within an urban Midwest setting were assessed, focusing on their accommodations for patients with obesity. Feedback from clinic staff was incorporated to further refine the checklist.Results: Common equipment deficiencies included extra‐large blood pressure cuffs, wheelchair‐accessible scales, 2XL gowns, and adequate seat dimensions in the waiting area. Healthcare workers reported moral distress for their patients when unable to provide proper care due to these limitations. Newly constructed clinics exhibited better‐equipped facilities for patients with obesity.Conclusions: Many clinics lack proper equipment to accommodate patients with obesity, resulting in negative care experiences. This clinical environment checklist can identify problem areas and provide solutions to create more welcoming environments, encouraging future care‐seeking behaviors.