Feasibility of expert and crowd-sourced review of intraoperative video for quality improvement of intracorporeal urinary diversion during robotic radical cystectomy

  • Mitchell G. Goldenberg Division of Urology Department of Surgery Sunnybrook Health Sciences Centre University of Toronto http://orcid.org/0000-0002-4601-5721
  • Jamal Nabhani USC Institute of Urology and Norris Comprehensive Cancer Center, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA
  • Christopher J.D. Wallis Division of Urology Department of Surgery Sunnybrook Health Sciences Centre University of Toronto
  • Sameer Chopra USC Institute of Urology and Norris Comprehensive Cancer Center, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA
  • Andrew J. Hung USC Institute of Urology and Norris Comprehensive Cancer Center, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA
  • Anne Schuckman USC Institute of Urology and Norris Comprehensive Cancer Center, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA
  • Hooman Djaladat USC Institute of Urology and Norris Comprehensive Cancer Center, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA
  • Siamak Daneshmand USC Institute of Urology and Norris Comprehensive Cancer Center, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA
  • Mihir M. Desai USC Institute of Urology and Norris Comprehensive Cancer Center, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA
  • Monish Aron USC Institute of Urology and Norris Comprehensive Cancer Center, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA
  • Inderbir S. Gill USC Institute of Urology and Norris Comprehensive Cancer Center, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA
  • Raj Satkunasivam Division of Urology Department of Surgery Sunnybrook Health Sciences Centre University of Toronto

Abstract

Introduction: Development of uretero-ileal stricture (UIS) after robotic-assisted radical cystectomy (RARC) may be dependent on surgical technique. Video review of intraoperative technique is an emerging paradigm for surgical quality improvement. We examined whether surgeon-perceived risk of UIS or crowd-sourced assessment of robotic skill are associated with the development of UIS.

Methods: We conducted a case-control study comparing the operative technique of uretero-ileal anastomoses resulting in clinically significant UIS with the contralateral anastomosis for the same patient. De-identified videos were analyzed by 1) five high-volume surgeons; and 2) crowd workers (Crowd-Sourced Assessment of Technical Skill, C-SATS) to determine Global Evaluative Assessment of Robotic Skill (GEARS) score. Mantel-Haenszel common odds ratio (OR) estimates were calculated to assess the association between surgeon performance and the development of UIS. Logistic regression models were used to examine the association between GEARS scores and the development of UIS.

Results: A total of 10 UIS videos were compared to eight control videos by five surgeons and 2142 crowd workers. Expert surgeons systematically evaluated intraoperative footage, however, no association between the expert mode response and UIS (OR 0.42; 95% confidence interval [CI] 0.05‒3.45; p=0.91) was identified. Crowd-sourced assessment was not predictive of UIS (p=0.62).

Conclusions: We used video review to systematically analyze procedure-specific content and technique. The inability of surgeons to predict UIS may reflect the questionnaire, uncontrolled patient factors, or a lack of power. Crowd-sourced GEARS score was unsuccessful in predicting UIS after RARC.

Author Biography

Mitchell G. Goldenberg, Division of Urology Department of Surgery Sunnybrook Health Sciences Centre University of Toronto

PGY-3 Resident

Division of Urology

Department of Surgery

University of Toronto

Published
2017-10-12
How to Cite
Goldenberg, M. G., Nabhani, J., Wallis, C. J., Chopra, S., Hung, A. J., Schuckman, A., Djaladat, H., Daneshmand, S., Desai, M. M., Aron, M., Gill, I. S., & Satkunasivam, R. (2017). Feasibility of expert and crowd-sourced review of intraoperative video for quality improvement of intracorporeal urinary diversion during robotic radical cystectomy. Canadian Urological Association Journal, 11(10), 331-6. https://doi.org/10.5489/cuaj.4442
Section
Original Research