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Robotic Sacrocolpopexy Performance and Cumulative Summation Analysis

Myers, Erinn M. MD*; Geller, Elizabeth J. MD*; Connolly, AnnaMarie MD*; Bowling, James Michael PhD; Matthews, Catherine A. MD*

Female Pelvic Medicine & Reconstructive Surgery: March/April 2014 - Volume 20 - Issue 2 - p 83–86
doi: 10.1097/SPV.0000000000000044
Original Articles
Journal Club
Journal Club Q and A

Objectives This study aimed to apply Cumulative Summation (CUSUM) analysis as a tool to monitor robotic sacrocolpopexy (RSCP) proficiency over time.

Methods A retrospective analysis of all women who underwent RSCP between September of 2008 and December of 2011 at the University of North Carolina at Chapel Hill. The performance for 2 attending surgeons was analyzed sequentially over time. Intraoperative complications such as genitourinary or gastrointestinal tract injury, conversion to laparotomy, pulmonary embolus, hemorrhage, and blood transfusion, were identified by International Classification of Diseases, Ninth Revision and Current Procedural Terminology codes. A successful outcome was defined as no intraoperative complications. The target value of success was set at less than 10% complications. CUSUM analysis was then sequentially applied to all RSCP cases for 2 attending surgeons.

Results Over 27 months, 169 RSCPs were performed. The first surgeon performed 107 RSCPs and the second surgeon performed 62 RSCPs with 8 (7.4%) and 3 (4.9%) intraoperative complications, respectively. Total complications included 7 (4.1%) cystotomies, 2 (1.2%) vaginal lacerations, 1 (0.6%) blood transfusion, and 1 (0.6%) bowel perforation. A CUSUM graph was created for each surgeon.

Conclusions CUSUM analysis was successfully applied to monitor RSCP proficiency. Such testing of individual successive procedural outcomes with CUSUM may offer an objective tool to aid in physician self-assessment.

CUSUM analysis was successfully applied to monitor RSCP proficiency over time.

From the *Department of Obstetrics and Gynecology, and †Gillings School of International Public Health, University of North Carolina, Chapel Hill, NC.

Reprints: Erinn M. Myers, MD, Department of Obstetrics and Gynecology, University of North Carolina, 3023 Old Clinic Bldg, Campus Box 7570, Chapel Hill, NC 27599. E-mail:

Dr Catherine A. Matthews is a consultant of Intuitive Surgical and has received research support from the American Medical Systems. Dr Elizabeth J. Geller has received honoraria from Intuitive Surgical. The other authors have declared they have no conflicts of interest.

© 2014 by Lippincott Williams & Wilkins