Efficiency and Accuracy of Robotic Surgical Performance Decayed Among Urologists During COVID-19 Shutdown

Abstract

Journal of EndourologyVol. 35, No. 6 Letters to the Editor Edited by Dean Assimos, MdFree AccessEfficiency and Accuracy of Robotic Surgical Performance Decayed Among Urologists During COVID-19 ShutdownBalint Der, Daniel Sanford, Ryan Hakim, Erik Vanstrum, Jessica H. Nguyen, and Andrew J. HungBalint DerCatherine & Joseph Aresty Department of Urology, Center for Robotic Simulation & Education, University of Southern California, Institute of Urology, Los Angeles, California, USA.Search for more papers by this author, Daniel SanfordCatherine & Joseph Aresty Department of Urology, Center for Robotic Simulation & Education, University of Southern California, Institute of Urology, Los Angeles, California, USA.Search for more papers by this author, Ryan HakimCatherine & Joseph Aresty Department of Urology, Center for Robotic Simulation & Education, University of Southern California, Institute of Urology, Los Angeles, California, USA.Search for more papers by this author, Erik VanstrumCatherine & Joseph Aresty Department of Urology, Center for Robotic Simulation & Education, University of Southern California, Institute of Urology, Los Angeles, California, USA.Search for more papers by this author, Jessica H. NguyenCatherine & Joseph Aresty Department of Urology, Center for Robotic Simulation & Education, University of Southern California, Institute of Urology, Los Angeles, California, USA.Search for more papers by this author, and Andrew J. HungAddress correspondence to: Andrew J. Hung, MD, Catherine & Joseph Aresty Department of Urology, Center for Robotic Simulation & Education, University of Southern California, Institute of Urology, 1141 Eastlake Avenue, Suite 7416, Los Angeles, CA 90089-9178, USA E-mail Address: [email protected]Catherine & Joseph Aresty Department of Urology, Center for Robotic Simulation & Education, University of Southern California, Institute of Urology, Los Angeles, California, USA.Search for more papers by this authorPublished Online:17 Jun 2021https://doi.org/10.1089/end.2020.0869AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookXLinked InRedditEmail IntroductionThe COVID-19 pandemic has severely impacted health care delivery worldwide. In March 2020, the United States Surgeon General recommended postponing all elective procedures in the United States, resulting in a dramatic decrease in caseloads across surgical specialties.1 The potential degradation of surgical skills during the pandemic and this surgical hiatus has not yet been studied. The association between surgeon performance and clinical outcomes is strong.2 Our own study has demonstrated that suturing performance is associated with long-term recovery of urinary continence after robotic prostatectomy.3 Herein, we evaluate suturing skill degradation succeeding the COVID-19 shutdown.MethodsSurgeons completed a series of robotic virtual reality (VR) exercises immediately before and after a mandated 6-week surgical hiatus (Fig. 1a). Assessment of computer-generated metrics and objective robotic surgical skills has been extensively studied and validated in VR simulation.4 We collected simulator generated metrics of surgeon efficiency and precision (Fig. 1b). In addition, three independent and blinded reviewers (B.D., D.S., and R.H.) evaluated suturing technical skill utilizing a validated assessment tool.5 Reviewers initially assessed cases independently before reaching a consensus score for discrepant gradings. Surgeons reported their perception of skills based on a survey questionnaire postshutdown. Depending on the results of the D'Agostino–Pearson normality test, comparisons of surgical performance before/after the shutdown were performed with either paired Student's t-test or Wilcoxon-matched signed-rank test. The graphical presentations of subgroup analyses were omitted where p > 0.05.FIG. 1. Study overview and assessment parameters. (a) The study time