Using a modified Delphi process to explore international surgeon-reported benefits of robotic-assisted surgery to perform abdominal rectopexy,Techniques in Coloproctology

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Using a modified Delphi process to explore international surgeon-reported benefits of robotic-assisted surgery to perform abdominal rectopexy
Techniques in Coloproctology ( IF 2.7 ) Pub Date : 2022-08-20 , DOI: 10.1007/s10151-022-02679-w
T Keating ₁ , C A Fleming ₁ , A E Brannigan ₁ ,

Affiliation

Background

Robotic-assisted surgery (RAS) offers improved visualisation and dexterity compared to laparoscopy. As a result, RAS is considered an attractive option for performing rectopexy, particularly in the confines of the lower pelvis. The aim of this study was to explore the benefits of RAS in rectopexy by analysing the views of a group of surgeons will have published on robotic rectopexy.

Methods

A three-round Delphi process was performed. Combined qualitative, Likert scale and binary responses were utilised in rounds one and two with binary responses seeking overall consensus in round two and three. Particular areas that were studied included: clinical aspects of patient selection, technical aspects of using RAS to perform rectopexy, ergonomic factors, training, and consideration of the ‘learning-curve’. Consensus was defined as agreement > 80% among participants. Potential experienced RAS rectopexy surgeons were identified using PubMed where authors of studies reporting outcomes from RAS rectopexy were searched and invited.

Results

Twenty surgeons participated from the following countries: France, Germany, Ireland, Italy, Netherlands, Switzerland, UK, and USA. Participants had median operative experience of 75 (range 20–450) rectopexies (all techniques) and 11(range 0–300) robotic-rectopexies for all indications. All participants agreed that patient-reported functional outcomes and improved quality-of-life were the most important outcomes following rectopexy. Participants agreed the most significant benefits offered by RAS for rectopexy were improved precision due to better visualisation (80%), improved dexterity (90%) and improved overall accuracy e.g., for suture placement (90%). Ninety percent agreed that the superior ergonomics of RAS rectopexy improved their performance on several steps of the operation, in particular: mesh fixation (85%) and rectovaginal dissection (80%). Consensus on the learning curve for RAS abdominal rectopexy was not achieved: forty-five percent (n = 9) reported the learning curve as 11–20 cases and 55% (n = 11) as 21–30 cases.

Conclusions

A panel of surgeons who had published on RAS view that it positively improves performance of rectopexy in terms of technical skills, improved dexterity and visualisation and ergonomics.

中文翻译：

使用改进的 Delphi 过程探索国际外科医生报告的机器人辅助手术进行腹部直肠固定术的好处

背景

与腹腔镜检查相比，机器人辅助手术 (RAS) 提供了更好的可视化和灵巧性。因此，RAS 被认为是进行直肠固定术的一个有吸引力的选择，特别是在下骨盆的范围内。本研究的目的是通过分析一组将发表的关于机器人直肠固定术的外科医生的观点，探索 RAS 在直肠固定术中的好处。

方法

执行了三轮德尔菲过程。在第一轮和第二轮中结合了定性、李克特量表和二元反应，二元反应在第二轮和第三轮中寻求总体共识。研究的特定领域包括：患者选择的临床方面、使用 RAS 进行直肠固定术的技术方面、人体工程学因素、培训和对“学习曲线”的考虑。共识被定义为参与者之间的协议 > 80%。使用 PubMed 确定了潜在有经验的 RAS 直肠固定术外科医生，其中搜索并邀请了报告 RAS 直肠固定术结果的研究作者。

结果

来自以下国家的 20 名外科医生参加：法国、德国、爱尔兰、意大利、荷兰、瑞士、英国和美国。对于所有适应症，参与者的中位手术经验为 75 次（范围 20-450 次）直肠固定术（所有技术）和 11 次（范围 0-300 次）机器人直肠固定术。所有参与者都同意，患者报告的功能结果和生活质量的改善是直肠固定术后最重要的结果。参与者一致认为，RAS 为直肠固定术提供的最显着好处是由于更好的可视化 (80%)、灵巧性 (90%) 和缝合位置 (90%) 等总体准确性而提高了精确度。90% 的人同意 RAS 直肠固定术卓越的人体工程学设计提高了他们在手术的几个步骤中的表现，特别是：网状固定 (85%) 和直肠阴道剥离 (80%)。未达成 RAS 腹部直肠固定术学习曲线的共识：百分之四十五 (n = 9) 报告学习曲线为 11-20 个案例，55% ( n = 11) 报告为 21-30 个案例。