Assessing operative variability in robot-assisted radical prostatectomy (RARP) through AI.

Abstract

Robotic-assisted radical prostatectomy (RARP) is the most commonly performed robotic procedure in urology. Using artificial intelligence (AI), surgical steps and practices can be assessed and validated through surgical video, and connected to patient outcomes. This information can potentially change clinical outcomes and improve the quality of care. 48. We conducted an analysis of 883 RARP cases from 2017 to 2023, across six different institutions. A surgical intelligence platform (Theator Inc., Palo Alto, CA) was employed during all surgeries, and used to identify six surgical practices: bladder neck suture, leak test, Rocco stitch, standard dorsal venous complex (DVC) ligation (S-DVC), delayed DVC ligation (D-DVC), and Retzius-space reconstruction. We analyzed descriptive statistics, including frequencies and measures of central tendency. Categorical variables were presented using frequency and percentage. Continuous variables were presented with median and interquartile range. 87. Institution A had the highest number of cases (n = 675, 76.4%), followed by Institution B (n = 127, 14.4%), Institution C (n = 48, 5.4%), Institution D (n = 20, 2.3%), Institution E (n = 9, 1.0%), and Institution F (n = 4, 0.5%). The mean surgical duration across institutions was 163.4 min ± 56.6. The surgical intelligence platform identified the following median rates of surgical practice adoption across institutions: bladder neck suture (32.9%, range: 50-0%), leak test (92.9%, range: 95.8-77.7%), Rocco stitch (18.3%, range: 75-0%), S-DVC ligation (40.2%, range: 100-0%), D-DVC ligation (87.3%, range: 98.4-11.1%), and Retzius-space reconstruction (0%, range: 5-0%). 103. This study demonstrates how surgical intelligence is utilized to assess different key surgical steps in RARP videos, enabling objective, accurate measurement of variability in practices among institutions. Surgical intelligence increases the availability of surgical metrics across institutions and surgeons and facilitates mitigation of adverse effects by informing the usage of best practices, potentially leading to better clinical outcomes and a higher quality of care. 72.