Scoring In Robotic Coronary Surgery
Ludovic Melly, Grégory Kalscheuer, Philippe Eucher, Tarek Announe, Peter Schraverus, Asamae Belhaj, Benoît Rondelet, Jean-Luc Jansens.
CHU UCL Namur, Yvoir, Belgium.
OBJECTIVE: To assess the robotic performance for beating heart totally endoscopic coronary artery bypass (BHTECAB).
METHODS: Robotically assisted procedures are very demanding in terms of resources, technical skills and costs. Team building and surgical technique need to be developed jointly and monitored in order to assure efficacy and safety. First we reviewed different robotic skills assessment scores available in the literature. Second we standardized step by step the BHTECAB procedure, defined as a single coronary artery bypass with the internal mammary artery to left anterior descending coronary artery. Then we compared them to our scoring system used in a mentoring program to evaluate the learning curve in starting robotic coronary revascularization programs.
RESULTS: Main assessment scores described in the literature are either not specific for the robot or not specially made for evaluating cardiac surgeries. Indeed the Healthcare Failure Mode and Effect Analysis (HFMEA) is a form of human risk analysis derived from the aviation and validated for use in health care but not specifically for surgeries. The Objective Structured Assessment of Technical Skills (OSATS) is a pure measurement to the surgical performance for specific non-cardiac procedures. Similarly the Global Evaluation Assessment of Robotic Surgery (GEARS) is an adaptation of the Global Operative Assessment of Laparoscopic Skills (GOALS) score and modified to include the parameters of robotic and force controls, which makes this score the most accurate for robotic assessment and seems by now to be validated for other robotic surgeries such as in urology. But it considers only the surgeon’s performance indifferently to the procedure. We combined this GEARS with our standardized BHTECAB and developed a new score. The specific evaluation describes and assesses the procedure itself. The general part considers the console surgeon’s skills (Figure1). The two sections involve both the console and patient surgeons as well as their interaction with the whole team.
CONCLUSIONS: Standardized scoring systems help newly formed teams and fellows to practice under monitoring and so allowing comparisons between centers.
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