title: Surgeon perception is not a good predictor of peri-operative outcomes in robot-assisted radical prostatectomy.
abstract: Surgeons have always used their cognitive intuition for the execution of skilled tasks and real-time perception of intra-operative outcomes. We attempted to measure the overall accuracy of intra-operative surgeon perception on the functional outcome of early continence after robot-assisted radical prostatectomy (RARP). A single experienced surgeon (D.I.L.) used a scoring sheet to prospectively capture his subjective opinion of how well a particular portion of the RARP procedure was completed. Surgeon perception of factors affecting post-operative continence such as quality of bladder neck preservation, nerve sparing, urethral length, anastomosis, striated sphincter thickness, quality of Rocco repair and bladder neck plication suture (total 7 variables) were graded as "poor", "average" or "good". Urinary continence was graded as either total continence [0 pads per day (PPD) or social continence (security pad or one PPD)]. A total of 273 (39 patients × 7 variables) responses were recorded: 58.6% were rated as "good", 32.2% as "average" and 8.4% as "poor". A log-rank test for all perception variables showed no significant differences in subsequent achievement of continence (either 0 or 1 PPD) (P > 0.05) at both the 1- and 3-month time points. In the case of some perception variables, patients with "bad" scores gained continence a median of 3 weeks sooner than patients with "good" scores. Surgeon perception of intra-operative performance during RARP is a poor predictive indicator of subsequent functional outcome in terms of urinary continence. Inter-surgeon variability of perception may vary and needs further investigation.
authors.affiliation: Division of Urology, Penn Presbyterian Medical Center, University of Pennsylvania, 51 North 39th Street, Medical Office Building Suite 300, Philadelphia, PA, 19104, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Stern
authors.affiliation: Division of Urology, Penn Presbyterian Medical Center, University of Pennsylvania, 51 North 39th Street, Medical Office Building Suite 300, Philadelphia, PA, 19104, USA.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Sharma
authors.affiliation: Division of Urology, Penn Presbyterian Medical Center, University of Pennsylvania, 51 North 39th Street, Medical Office Building Suite 300, Philadelphia, PA, 19104, USA.
authors.forename: Pierre
authors.initials: P
authors.lastname: Mendoza
authors.affiliation: Division of Urology, Penn Presbyterian Medical Center, University of Pennsylvania, 51 North 39th Street, Medical Office Building Suite 300, Philadelphia, PA, 19104, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Walicki
authors.affiliation: Division of Urology, Penn Presbyterian Medical Center, University of Pennsylvania, 51 North 39th Street, Medical Office Building Suite 300, Philadelphia, PA, 19104, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Hastings
authors.affiliation: Division of Urology, Penn Presbyterian Medical Center, University of Pennsylvania, 51 North 39th Street, Medical Office Building Suite 300, Philadelphia, PA, 19104, USA.
authors.forename: Kelly
authors.initials: K
authors.lastname: Monahan
authors.affiliation: Division of Urology, Penn Presbyterian Medical Center, University of Pennsylvania, 51 North 39th Street, Medical Office Building Suite 300, Philadelphia, PA, 19104, USA.
authors.forename: Baber
authors.initials: B
authors.lastname: Sheikh
authors.affiliation: Division of Urology, Penn Presbyterian Medical Center, University of Pennsylvania, 51 North 39th Street, Medical Office Building Suite 300, Philadelphia, PA, 19104, USA.
authors.forename: Alexei
authors.initials: A
authors.lastname: Wedmid
authors.affiliation: Division of Urology, Penn Presbyterian Medical Center, University of Pennsylvania, 51 North 39th Street, Medical Office Building Suite 300, Philadelphia, PA, 19104, USA. david.i.lee@uphs.upenn.edu.
authors.forename: David I
authors.initials: DI
authors.lastname: Lee
keywords: Prostate cancer; Radical prostatectomy; Robotic prostatectomy; Robotic surgery