MP05-12 VALIDATED SURGICAL STEPS OF THE ROBOTIC ASSISTED SACROCOLPOPEXY OPERATION

Abstract

INTRODUCTION AND OBJECTIVE: Robotic surgery presents new challenges in surgical training. There is a learning curve associated with new technology and console time is split between surgeon and trainee. These challenges are compounded by limitations of time and resources. To remedy this, modular training and assessment tools have been developed for other surgeries, utilizing a form of human risk analysis known as Healthcare Failure Mode and Effect Analysis (HFMEA) that considers both learning curves (LCs) and technical competence attained by trainees. The first step to developing these tools is to map the process steps in a structured fashion with expert consensus while also identifying high-risk steps that could result in an adverse event. Here we apply this methodology to the robotic-assisted sacrocolpopexy (RASC) operation. METHODS: An expert panel, including six experts from two high-volume tertiary referral centers, identified the surgical procedure steps involved in the RASC procedure through consensus. These steps were then assigned a “hazard-score” which is a function of the difficulty of the step and the severity of potential errors made at this step. RESULTS: The expert panel developed the steps of the RASC procedure, assigned the level of difficulty (how challenging the step is to perform, range I-IV) and determined the risk associated with each step (ie level of potential patient harm with the presence of an error, range IIV, Table 1) with little to no disagreement. However, significant variation was noted when determining how to combine the RASC with other reconstructive procedures. Additionally, there was a lack of data available to guide this decision. CONCLUSIONS: We present a validated stepwise description of the RASC procedure with concomitant hazard-scores. Given the number of pelvic organ prolapse (POP) procedures performed (>200,000 in the United States annually) and that management for POP continues to evolve (i.e. the withdrawal of transvaginal mesh from the market) it is important that surgical training include all available options. This validated procedural map could be a valuable tool as national standardization of technique during training may help improve outcomes. Future work involves completing the HFMEA by evaluating the reliability, validity and educational impact of our work. (Figure Presented).