MP20-17 INCORPORATION OF CLINICALLY RELEVANT PERFORMANCE METRICS (CRPMS) INTO A ROBOT ASSISTED RADICAL PROSTATECTOMY SIMULATION MODEL

Abstract

INTRODUCTION AND OBJECTIVES: Surgical education is dependent on live patients for operative exposure and cultivation of surgical technique. Robotic assisted nerve-sparing prostatectomy is a unique surgery requiring both oncologic and functional outcomes for success. The steep learning curve of nerve-sparing prostatectomy provides a significant need for surgical education outside of the live patient operative room exposure. In our study, we validate a high-fidelity, inanimate robotic assisted nerve-sparing prostatectomy model within a full-immersion simulation environment with performance metrics feedback. METHODS: Anatomically accurate models of the human pelvis, bladder, prostate, urethra, neurovascular bundle (NVB) and relevant adjacent structures were created using polyvinyl alcohol (PVA) hydrogels and three-dimensional-printed injection molds. Pertinent steps of the nerve-sparing prostatectomy were simulated: bladder neck dissection, seminal vesicle mobilization, nerve-sparing prostatectomy and urethral anastomosis. Five experts (>250 caseload) and 9 novices were (<50 caseload) completed the simulation. Force trauma applied to the NVB during the dissection was quantified by a novel tension wire sensor system within the NVB. GEARS scores were calculated by 2 blinded surgeons and correlated to forces applied to the NVB. After resection, margin status was measured grossly and microscopically by prostatic fluorescent dye within each prostatic mold. Robotic Anastomosis Competency Evaluation (RACE) was performed and all anastomosis were leak tested. RESULTS: The model displayed excellent face and content validity with an average score of #/5 and #/5, respectively. There were significant differences between novice and expert operative time; both total and for every step. Operative metrics differed between novices and experts: nerve tension, either gross or microscopic positive margin, estimated blood loss, bladder neck anastomosis. Experts compared to novices achieved better operative times, negative margins, lower forces applied to NVB and leak free anastomosis. CONCLUSIONS: We demonstrated face, content and construct validity of an inanimate, full task trainer for nerve-sparing prostatectomy. Construct validity was demonstrated between experts and novices using procedural metrics, which permitted accurate assessment of performance. We reveal a full-immersion simulation to provide comprehensive surgical skill development and evaluation before hands-on exposure that can develop essential skills for suitable nerve-sparing prostatectomy performance.