Surgeon perception is not a good predictor of peri-operative outcomes in robot-assisted radical prostatectomy

Joshua Stern, Saurabh Sharma, Pierre Mendoza, Mary Walicki, Rachel Hastings, Kelly Monahan, Baber Sheikh, Alexei Wedmid, David I. Lee

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Surgeons have always used their cognitive intuition for the execution of skilled tasks and real-time perception of intra-operative outcomes. We attempted to measure the overall accuracy of intra-operative surgeon perception on the functional outcome of early continence after robot-assisted radical prostatectomy (RARP). A single experienced surgeon (D. I. L.) used a scoring sheet to prospectively capture his subjective opinion of how well a particular portion of the RARP procedure was completed. Surgeon perception of factors affecting post-operative continence such as quality of bladder neck preservation, nerve sparing, urethral length, anastomosis, striated sphincter thickness, quality of Rocco repair and bladder neck plication suture (total 7 variables) were graded as "poor", "average" or "good". Urinary continence was graded as either total continence [0 pads per day (PPD) or social continence (security pad or one PPD)]. A total of 273 (39 patients × 7 variables) responses were recorded: 58.6% were rated as "good", 32.2% as "average" and 8.4% as "poor". A log-rank test for all perception variables showed no significant differences in subsequent achievement of continence (either 0 or 1 PPD) (P > 0.05) at both the 1- and 3-month time points. In the case of some perception variables, patients with "bad" scores gained continence a median of 3 weeks sooner than patients with "good" scores. Surgeon perception of intra-operative performance during RARP is a poor predictive indicator of subsequent functional outcome in terms of urinary continence. Inter-surgeon variability of perception may vary and needs further investigation.

Original languageEnglish (US)
Pages (from-to)283-288
Number of pages6
JournalJournal of Robotic Surgery
Issue number4
StatePublished - Dec 2011
Externally publishedYes


  • Prostate cancer
  • Radical prostatectomy
  • Robotic prostatectomy
  • Robotic surgery

ASJC Scopus subject areas

  • Surgery
  • Health Informatics


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