Objective performance indicators differ in obese and nonobese patients during robotic proctectomy

• Published in: Surgery 2024-12, Vol.176 (6), p.1591-1597
• Main Authors: Gillani, Mishal, Rupji, Manali, Paul Olson, Terrah J., Sullivan, Patrick, Shaffer, Virginia O., Balch, Glen C., Shields, Mallory C., Liu, Yuan, Rosen, Seth A.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biomechanical Phenomena; Feasibility Studies; Female; Humans; Male; Middle Aged; Obesity - surgery; Proctectomy - adverse effects; Proctectomy - methods; Robotic Surgical Procedures - methods
• ISSN: 0039-6060; 1532-7361; 1532-7361
• DOI: 10.1016/j.surg.2024.08.015

Robotic surgery is perceived to be more complex in obese patients. Objective performance indicators, machine learning–enabled metrics, can provide objective data regarding surgeon movements and robotic arm kinematics. In this feasibility study, we identified differences in objective performance indicators during robotic proctectomy in obese and nonobese patients. Endoscopic videos were annotated to delineate individual surgical steps across 39 robotic proctectomies (1880 total steps). Thirteen patients were obese and 26 were nonobese. Objective performance indicators during the following steps were analyzed: splenic flexure mobilization, left colon mobilization, pelvic dissection, and rectal transection. The following differences were noted during robotic proctectomy in obese patients: during splenic flexure mobilization, more arm swaps, longer camera path length and velocity; during left colon mobilization, longer step time, more arm swaps, higher camera-related metrics (movement, path length, velocity, acceleration, and jerk), greater dominant arm path length, moving time, and wrist articulation; during anterior pelvic dissection, longer energy activation time, camera path length, and moving time; during posterior pelvic dissection, lower nondominant arm velocity, jerk, and acceleration; during left pelvic dissection, longer energy activation time; during right pelvic dissection, greater camera-related metrics (movement, path length, moving time, and velocity); and during rectal transection, longer step time, more arm swaps, master clutch use and camera movements, greater dominant wrist articulation, and longer dominant arm path length. We report step-specific objective performance indicators that differ during robotic proctectomy for obese and nonobese patients. This is the first study to use objective performance indicators to correlate a patient attribute with surgeon movements and robotic arm kinematics during robotic colorectal surgery.