Study finds gynecologic oncology ranks highest in robotic surgical proficiency

Dr. ProsperWhen it comes to robotic surgical dexterity, gynecologic oncology ranks higher than other disciplines, according to the results of a crowd-sourced assessment of technical skills (C-SATS) presented at the 46^th AAGL Global Congress on Minimally Invasive Gynecology.

“C-SATS is an interoperative online review system that basically analyzes surgeons on their robotic skills,” says principal investigator Rachel Prosper, MD, an ob/gyn resident at Northwell Health in Manhasset, NY.

A qualified reviewer anonymously critiqued a total of 155 robotic videos of different procedures from 36 surgeons.

The six medical specialties represented were benign gynecology (11 cases), urogynecology (20), gynecologic oncology (16), general surgery (60), urology (25) and cardiothoracic surgery (23).

The wide range of surgeries assessed included hysterectomies, myomectomies, sacral-colpopexies, gastrectomies, pancreatectomies and coronary artery bypass surgeries.

Surgeons were scored in five skill sets: bimanual dexterity, robotic control, depth perception, force sensitivity and efficiency. Using the Global Evaluative Assessment of Robotic Skills (GEARS) Assessment Tool, each individual skill set was graded on a scale of 1 – 5, for a total perfect score of 25.

“A lot of the judging was subjective and limited to the video submitted by the surgeon,” Dr. Prosper told Contemporary OB/GYN.

After scoring, a biostatistician used analysis of variance (ANOVA) to compare the mean C-SATS with the individual specialties. The biostatistician also used the Tukey-Kramer test for further association.

The gynecologic oncology group had a total mean score of 20.94, which was the highest of any of the participating specialties. Conversely, the general surgery and benign gynecology groups each had the lowest score of 19.74.

“We found that surgeons with an increased number of cases achieved a better score with C-SATS,” Dr. Prosper says.

As to why gynecologic oncology scored the best, “it might be because the oncologic surgeons have the most experience and perform more cases with a higher comfort level,” Dr. Prosper explains.

Dr. Prosper says she is not surprised by any of the study’s findings. “In the field of gynecologic oncology, surgeons are normally highly regarded and highly trained and skilled in robotic surgeries. They typically do these cases day in and day out,” she says. “Thus, I am not surprised that they received the highest score.”

The study was inspired by co-author Michael Nimaroff, MD, senior vice president and executive director of ob/gyn services at Northwell Health, who served as Dr. Prosper’s mentor for the project. Dr. Nimaroff wanted to demonstrate Northwell Health’s initial experience with C-SATS and how the score correlated with the surgeon’s individual experience.   

Dr. Prosper said that overall, “robotics is an awesome tool for both the patient and the clinician, in part because patients are normally discharged the same day or the day after surgery. This technology also improves postoperative pain and decreases use of narcotics.”

To improve robotic dexterity, Dr. Prosper recommends that surgeons practice on a console as much as possible.

Dr. Prosper said the value of such a video review process can aid institutions in initial credentialing or/and recredentialing of robotic surgeons.

In the future, the hope is to ascertain if there are any correlations between a surgeon’s C-SATS scores with patient outcomes and operative times.

Dr. Prosper reports no relevant financial disclosures.

Reference

Prosper R, Nimaroff M. Initial experience with crowd sourced assessment of technical skills. [AAGL abstract 149]. J Minim Invasive Gynecol. 2017;24(suppl):S61.