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Ma R, Ramaswamy A, Xu J, Trinh L, Kiyasseh D, Chu TN, Wong EY, Lee RS, Rodriguez I, DeMeo G, Desai A, Otiato MX, Roberts SI, Nguyen JH, Laca J, Liu Y, Urbanova K, Wagner C, Anandkumar A, Hu JC, Hung AJ. Surgical gestures as a method to quantify surgical performance and predict patient outcomes. NPJ Digit Med 2022; 5:187. [PMID: 36550203 PMCID: PMC9780308 DOI: 10.1038/s41746-022-00738-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
How well a surgery is performed impacts a patient's outcomes; however, objective quantification of performance remains an unsolved challenge. Deconstructing a procedure into discrete instrument-tissue "gestures" is a emerging way to understand surgery. To establish this paradigm in a procedure where performance is the most important factor for patient outcomes, we identify 34,323 individual gestures performed in 80 nerve-sparing robot-assisted radical prostatectomies from two international medical centers. Gestures are classified into nine distinct dissection gestures (e.g., hot cut) and four supporting gestures (e.g., retraction). Our primary outcome is to identify factors impacting a patient's 1-year erectile function (EF) recovery after radical prostatectomy. We find that less use of hot cut and more use of peel/push are statistically associated with better chance of 1-year EF recovery. Our results also show interactions between surgeon experience and gesture types-similar gesture selection resulted in different EF recovery rates dependent on surgeon experience. To further validate this framework, two teams independently constructe distinct machine learning models using gesture sequences vs. traditional clinical features to predict 1-year EF. In both models, gesture sequences are able to better predict 1-year EF (Team 1: AUC 0.77, 95% CI 0.73-0.81; Team 2: AUC 0.68, 95% CI 0.66-0.70) than traditional clinical features (Team 1: AUC 0.69, 95% CI 0.65-0.73; Team 2: AUC 0.65, 95% CI 0.62-0.68). Our results suggest that gestures provide a granular method to objectively indicate surgical performance and outcomes. Application of this methodology to other surgeries may lead to discoveries on methods to improve surgery.
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Affiliation(s)
- Runzhuo Ma
- grid.42505.360000 0001 2156 6853Center for Robotic Simulation & Education, Catherine & Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles, CA USA
| | - Ashwin Ramaswamy
- grid.5386.8000000041936877XDepartment of Urology, Weill Cornell Medicine, New York, NY USA
| | - Jiashu Xu
- grid.42505.360000 0001 2156 6853Computer Science Department, Viterbi School of Engineering, University of Southern California, Los Angeles, CA USA
| | - Loc Trinh
- grid.42505.360000 0001 2156 6853Computer Science Department, Viterbi School of Engineering, University of Southern California, Los Angeles, CA USA
| | - Dani Kiyasseh
- grid.20861.3d0000000107068890Department of Computing & Mathematical Sciences, California Institute of Technology, Pasadena, CA USA
| | - Timothy N. Chu
- grid.42505.360000 0001 2156 6853Center for Robotic Simulation & Education, Catherine & Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles, CA USA
| | - Elyssa Y. Wong
- grid.42505.360000 0001 2156 6853Center for Robotic Simulation & Education, Catherine & Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles, CA USA
| | - Ryan S. Lee
- grid.42505.360000 0001 2156 6853Center for Robotic Simulation & Education, Catherine & Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles, CA USA
| | - Ivan Rodriguez
- grid.42505.360000 0001 2156 6853Center for Robotic Simulation & Education, Catherine & Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles, CA USA
| | - Gina DeMeo
- grid.5386.8000000041936877XDepartment of Urology, Weill Cornell Medicine, New York, NY USA
| | - Aditya Desai
- grid.42505.360000 0001 2156 6853Center for Robotic Simulation & Education, Catherine & Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles, CA USA
| | - Maxwell X. Otiato
- grid.42505.360000 0001 2156 6853Center for Robotic Simulation & Education, Catherine & Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles, CA USA
| | - Sidney I. Roberts
- grid.42505.360000 0001 2156 6853Center for Robotic Simulation & Education, Catherine & Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles, CA USA
| | - Jessica H. Nguyen
- grid.42505.360000 0001 2156 6853Center for Robotic Simulation & Education, Catherine & Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles, CA USA
| | - Jasper Laca
- grid.42505.360000 0001 2156 6853Center for Robotic Simulation & Education, Catherine & Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles, CA USA
| | - Yan Liu
- grid.42505.360000 0001 2156 6853Computer Science Department, Viterbi School of Engineering, University of Southern California, Los Angeles, CA USA
| | - Katarina Urbanova
- grid.459927.40000 0000 8785 9045Department of Urology and Urologic Oncology, St. Antonius-Hospital, Gronau, Germany
| | - Christian Wagner
- grid.459927.40000 0000 8785 9045Department of Urology and Urologic Oncology, St. Antonius-Hospital, Gronau, Germany
| | - Animashree Anandkumar
- grid.20861.3d0000000107068890Department of Computing & Mathematical Sciences, California Institute of Technology, Pasadena, CA USA
| | - Jim C. Hu
- grid.5386.8000000041936877XDepartment of Urology, Weill Cornell Medicine, New York, NY USA
| | - Andrew J. Hung
- grid.42505.360000 0001 2156 6853Center for Robotic Simulation & Education, Catherine & Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles, CA USA
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