Each step taken during a surgical procedure can be directly linked to patient recovery outcomes.
This is according to a new study published in the journal JAMA Surgery, which examined the recovery of sexual function following prostate cancer surgery.
Investigators coined the term ‘surgical gestures’ to describe the smallest moment-to-moment movements a surgeon takes to complete a procedure.
Andrew Hung, a urologic surgeon, associate professor of Urology at Cedars-Sinai and senior author of the study, said: ‘These surgical gestures are as minute as a single movement of an instrument, a single cut of tissue or a single retraction of tissue.’
Investigators examined surgical videos of 157 patients undergoing robotic-assisted radical prostatectomy, then monitored to see if patients regained their sexual function one year after the procedures.
Hyung Kim, chair of the Department of Urology at Cedars-Sinai, said: ‘Radical prostatectomy is the most common treatment for localised prostate cancer, and robotic-assisted prostatectomy is the most common surgical procedure performed in the US. These findings have the potential to change outcomes for tens of thousands of patients each year.’
During these procedures, where the prostate is removed but the nerves responsible for sexual function are preserved, the surgeon is faced with a task much like peeling an orange, Hung said.
He explained: ‘Imagine the nerves as the orange peel. We are trying to separate the peel from the fruit without causing injury or harm, and it is a delicate act. This is a procedure we’ve been doing for decades, yet 27-81% of patients do not recover their sexual function, so we have room to improve.’
Because it can take up to a year of recovery to determine whether a patient’s sexual function will return, Hung said it has been challenging for surgeons to link actions during surgery to patient outcomes.
However, robotic procedures, which are routinely recorded for training purposes, provide a unique opportunity to capture a surgeon’s perspective. Investigators were also able to link certain gestures and the avoidance of others to the recovery of sexual function in patients.
Hung said: ‘One example is that during a procedure, a surgeon might retract or stretch the nerves in order to move them aside, and we found that increased use of retraction was linked with patients’ failure to recover sexual function. This could be because that pressure causes paralysis of the nerves even though they are physically preserved.’
The goal is to establish a library of evidence that links surgical gestures to patient outcomes, ultimately transforming surgical practice and enhancing results.
Hung, who is also an associate professor of Computational Biomedicine, explained: ‘Technique is passed down from one generation of surgeons to the next, but without data to back up what mentors are teaching their students. Until now, we haven’t had the right tools to assess surgical technique objectively. This study is meant to connect the dots between what surgeons do and how well their patients recover.’
Robots have it sewn up!
Meanwhile, robotic technology is also being harnessed to help new surgeons improve their suturing skills.
Findings from a preclinical study, once again led by urologic surgeon Andrew Hung, indicate that a new technology designed to help surgeons performing robot-assisted surgery ‘feel’ what the robotic tools are touching could improve novice surgeons’ suturing skills.
The research, published in the peer-reviewed journal Surgical Endoscopy, found that using Force Feedback-enabled robotic instruments allowed surgeons to suture with less force and fewer errors, all while taking less time and causing less tissue trauma.
Hung said: ‘For surgeons in training, robotic suturing can be challenging because too much force can damage tissue or break stitches, and too little force can lead to loose stitches. Force Feedback technology helps surgeons find the right balance. It proved beneficial in early testing, and now we’re eager to see how it could improve patient outcomes in real surgeries.’
