Surgeon's perception not predictive of robotic prostatectomy performance

Key Points

Munich, Germany-Surgeon perception is not a good predictive indicator of intraoperative performance and subsequent functional outcome in robot-assisted radical prostatectomy, say researchers from the University of Pennsylvania, Philadelphia.

That conclusion was based on a study of 39 consecutive patients in which a single experienced surgeon used a scoring sheet to prospectively capture his subjective opinion of how well individual elements of the robot-assisted procedure were completed. In a number of cases, patients with "bad" perceived results did well in terms of postoperative continence when compared with patients whose procedures were graded as "good."

"Continence recovery after robotic prostatectomy is a complex mechanism," said senior author David Lee, MD, assistant professor of surgery/urology at the University of Pennsylvania. "No one factor or nuance makes a large difference in continence results.

The study came about, Dr. Lee said, because he and his team "have found it frustrating that some patients do very well and others not so well early on after the robotic prostatectomy operation. I do about 10 to 12 prostates per week and have done more than 2,000 in my career, and I still can't accurately predict, based on intraoperative factors, who will do well continence-wise after the operation."

Dr. Lee performed the procedures and graded his work as "good," "average," or "bad" in each of seven intraoperative factors:

Of the 273 recorded responses (39 patients multiplied by seven variables), 59% were "good," 32.5% were "average," and 8.5% were "bad." There were no significant differences among the variables in reaching zero or one pad per day (p>.05) at both the 1- and 3-month time points.

"We did this study to see if there would be any particular factor that might lead to better early continence outcomes," Dr. Lee noted. "And patients who had a very good bladder neck-sparing operation did seem to have a slightly quicker continence recovery.

"But all in all, while we had hoped for something more definitive, we're not really surprised by the results."

'Bad' grades may mean good outcomes

Patients whose results were graded as "bad" in some variable outcomes did, in fact, have quicker continence recoveries, with a median time to reach social continence of 7 weeks versus 10 weeks for those patients whose results were graded as "good."

The authors noted that while surgeons "have always used their cognitive intuitive skills for execution of skilled tasks and real-time perception of the intraoperative outcomes," inter-surgeon perception can vary and may therefore warrant further investigation as it relates to functional outcomes.