Association of skill and errors with outcomes in robotic rectal cancer surgery.
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Authors
Boal, M
Reali, C
Duhoky, R
Gill, T
Khan, J
Miskovic, D
Francis, N
Issue Date
2025-12-10
Type
Journal Article
Language
en
Keywords
Assessment , Errors , Objective , Rectal cancer
Alternative Title
Abstract
Background: Proficiency-based progression is key to analyzing and improving surgical performance. Objective assessment has demonstrated a direct link between operative performance and outcomes in laparoscopic surgery but not in robotics. There is current research to automate assessment processes with sensor data and machine learning. This requires granular, reliable annotations to train clinically implementable, trusted models, to improve patient safety.
Aim: To evaluate objective skill and error tools in robotic rectal cancer surgery, to provide a granular validated dataset from which to train and test deep learning models.
Methodology: A national, ethically approved, multicentre study, Video Analysis in Minimally Invasive Surgery (VAMIS) (ClinicalTrials.gov NCT05279287), recorded robotic-assisted total mesorectal excision (RTME). Recruited participants were pseudonymised and clinical data were collected. Operations were recorded and uploaded to Touch Surgery™ using the DS1 computer (Digital Technologies, a Medtronic company) and annotated by independent, blinded raters. Objective assessment employed error, Objective Clinical Human Reliability Analysis (OCHRA), Modifiable-Global Evaluative Assessment in Robotic Skills (M-GEARS) and TME performance tools. Correlational and multivariable regression analyses were performed, investigating associations between intraoperative skill and errors with clinical outcomes.
Results: 30 RTME operations were recorded, annotating 538 errors (median 13/operation). Major consequential errors were significantly associated with complications (p = 0.031). Weighted error variables, accounting for error severity, were significantly associated with increased odds of prolonged operative time (p = 0.025). Inter-rater reliability demonstrated an excellent matched error agreement percentage of two raters (mean agreement 90% (range 68-100%), after calibration sessions). OCHRA was significantly correlated with M-GEARS (r = - 0.54 to - 0.77, p < 0.001-0.002) and the RTME performance tool (r = 0.74, p = 0.007).
Conclusion: This feasibility study validated the concept that granular error and skill annotations can be objectively measured and associated with clinical outcomes in robotic rectal cancer surgery. This is an important step for larger studies and in aiding the development of deep learning models to predict errors and skill.
Description
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Citation
Boal, M. et al. (2025) 'Association of skill and errors with outcomes in robotic rectal cancer surgery', Surgical Endoscopy. Available At: https://doi.org/10.1007/s00464-025-12393-x
Publisher
Springer Nature Link
License
© 2025. Crown.
Journal
Surgical endoscopy
Volume
Issue
PubMed ID
ISSN
1432-2218