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 9 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. Intersurgeon variability of perception may vary and needs further investigation.

Keywords Radical prostatectomy Robotic surgery Robotic prostatectomy Prostate cancer.