Technical Surgical Skill Assessment of Neurovascular Bundle Dissection and Urinary Continence Recovery After Robotic-Assisted Radical Prostatectomy

Abstract

Purpose: To examine the association between the quality of neurovascular bundle dissection and urinary continence recovery after robotic-assisted radical prostatectomy. Materials and Methods: Patients who underwent RARPs from 2016 to 2018 in 2 institutions with ≥1-year postoperative follow-up were included. The primary outcomes were time to urinary continence recovery. Surgical videos were independently assessed by 3 blinded raters using the validated dissection assessment for robotic technique (DART) tool after standardized training. Cox regression was used to test the association between DART scores and urinary continence recovery while adjusting for relevant patient features. Results: One hundred twenty one RARP performed by 23 surgeons with various experience levels were included. The median follow-up was 24 months (95% confidence interval [CI] 20-28 months). The median time to continence recovery was 7.3 months (95% CI 4.7-9.8 months). After adjusting for patient age, higher scores of certain DART domains, specifically tissue retraction and efficiency, were significantly associated with increased odds of continence recovery (P < .05). Conclusions: Technical skill scores of neurovascular bundle dissection vary among surgeons and correlate with urinary continence recovery. Unveiling the specific robotic dissection skillsets which affect patient outcomes has the potential to focus surgical training.