PD58-03 ASSOCIATIONS IN TECHNICAL SKILL BETWEEN SUCCESSIVE SUTURING SUB-STEPS

INTRODUCTION AND OBJECTIVE: Intra-operative surgeon performance has been associated with post-operative clinical outcomes and complications. Speci fi cally, our prior work found that suturing performance is linked to urinary continence recovery following robot-assisted radical prostatectomy. Herein, we analyze how the successive sub-steps of suturing are interrelated in terms of technical skill. METHODS: 22 surgeons completed a suturing exercise three times on the Mimic TM Flex VR simulator. Video recordings were dei-denti fi ed and assigned technical skill scores by three blinded, independent graders for each sub-step of suturing ( needle positioning (1), needle entry angle (2), needle driving (3) and needle withdrawal (4)). Assessments of suturing technical skill were derived from the clinically validated assessment tool Robotic Anastomosis Competency Evaluation (RACE). Hierarchical Poisson regression with Generalized Estimating Equation was used to examine the association between exposure and outcome by adopting the nested data structure of multiple training exercises within each trainee. We have adjusted potential confounders and tested effect modi fi ers in the Poisson model. RESULTS: Training (n [ 7, median caseload 0 (IQR 0-8)) and expert (n [ 15, 300 (165-750)) surgeons completed 428 individual suturing positions. 1,670 technical skill assessments were made. Ideal technical skill scores between needle positioning (1) and needle entry angle (2) (RR 1.12, p [ 0.05) , needle entry angle (2) and needle withdrawal (4) (RR 1.27 , p [ 0.03), and needle driving (3) and needle withdrawal (4) (RR 1.30, p [ 0.03) were found to be signi fi cantly positively associated with each other (Figure 1). With multivariate analysis, taking needle positioning score into account, a positive association for ideal technical skill scores between entry angle (2) and n eedle withdrawal (4) was found (RR 1.40, p < 0.01)