Objective performance indicators provide a novel, quantitative method to evaluate surgeon proficiency in robotic lobectomy training

Objective

Current evaluation of robotic surgeon proficiency relies on subjective assessment. The robotic platform collects highly granular kinematic data on surgeon activity, known as objective performance indicators (OPIs). We sought to compare surgeon proficiency during lobectomies across training levels using OPIs.

Methods

Under institutional review board approval, we analyzed robotic lobectomies between November 2022 and February 2023 performed by 2 expert robotic thoracic surgeons (>200 robotic lobectomies) and their trainees using OPI recorders. A professional annotator segmented each case into standardized steps, and an operating surgeon (trainee or attending) was assigned to that step on the basis of the active console. Kinematic data were compared between surgeon groups. A subgroup analysis was performed dividing the trainee group into junior (postgraduate year 3-5) and senior residents (postgraduate year 6-8).

Results

In total, 26 lobectomies with 410 discrete tasks performed by attending surgeons and 344 by trainees were included. In the attending group, there were significantly greater rates of camera clutching per minute compared with trainees (2.94 vs 2.52, respectively; P = .0005). The ratio of right to left hand use was significantly greater in the trainee group (1.52 vs 1.48, P = .0047). Average instrument speed was faster in the attending group (1.24 vs 1.13 meters/min, P = .0061). Differences in clutching and speed, but not hand dexterity, remained significant when the trainee group was subdivided into beginner and intermediate robotic surgeons.

Conclusions

There are significant differences in objective performance indicators between expert and beginner robotic surgeons. These results demonstrate the feasibility of incorporating kinematic performance data into thoracic surgeon assessment in a clinical setting.