CUA 2018: Quantifying the “Assistant Effect” in Robotic-Assisted Radical Prostatectomy: Measures of Technical Performance

Halifax, Nova Scotia ( While robotic-assisted surgery provides improvements over open and laparoscopic surgeries and several other advantages, it imparts several technical challenges to the surgeon. Namely, this approach requires an additional assistant to complete the important technical steps of the procedure. Surgeon's learning curve with robotic surgery of the prostate and kidney has been extensively been evaluated and reported. However, the role of the assistant and his technical skills on a surgeon’s performance has never been studied.  

Mitchell Goldenberg, MD, presented a study looking at bedside assistant skill in robotic surgery and quantifying the effect of assistant skill on surgeon technical performance during robotic-assisted radical prostatectomy (RARP). Authors collected videos from RARP cases from 3 hospitals. For the purpose of the study, the dissection of the prostatic pedicle and neurovascular bundle step was selected. Each video was rated by at least two independent expert analysts (figure 1). 

The study is first of this nature to attempt to investigate the relationship between assistant technical skill and surgeon performance for RARP. Validity evidence established for a OSATS tool, accuracy and reliability for assessing assistant skill in RAS. Interesting finding of the study is that the surgeons with greater experience (>100 cases) are disproportionately affected by technical ability of bedside assistant during RARP (figure 3). 

Presented by Mitchell Goldenberg, MD, University of Toronto
Co-Authors: Hossein Saadat, Antonio Finelli, Rajiv Singal, Teodor Grantcharov

Written by Zhamshid Okhunov, MD, Twitter: @OkhunovZham, Department of Urology, University of California-Irvine at the 73rd Canadian Urological Association Annual Meeting - June 23 - 26, 2018 - Halifax, Nova Scotia