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After reviewing lots of of hours of surgical video, a workforce led by Cedars-Sinai investigators has created a system that hyperlinks particular steps carried out throughout a surgical process to how nicely sufferers get well. The research, printed within the journal JAMA Surgical procedure, targeted on restoration of sexual perform following prostate most cancers surgical procedure, and investigators say the strategy may very well be utilized extra broadly.
Investigators coined the time period “surgical gestures” to explain the smallest moment-to-moment actions made by a surgeon to finish a process.
“These surgical gestures are as minute as a single movement of an instrument, a single cut of tissue or a single retraction of tissue, for example,” mentioned Andrew Hung, MD, a urologic surgeon, affiliate professor of Urology at Cedars-Sinai and senior creator of the research. “The gestures work something like an alphabet. You can string them together to form a surgical procedure the way you string letters together to form words.”
Investigators reviewed surgical video of 157 sufferers present process robotic-assisted radical prostatectomy, then adopted as much as decide whether or not sufferers recovered their sexual perform one yr after the procedures.
“Radical prostatectomy is the most common treatment for localized prostate cancer and robotic-assisted prostatectomy is the most common surgical procedure performed in the U.S.,” mentioned Hyung Kim, MD, chair of the Division of Urology at Cedars-Sinai. “These findings have the potential to change outcomes for tens of thousands of patients each year.”
Throughout these procedures, the place the prostate is eliminated however the nerves liable for sexual perform are preserved, the surgeon is confronted with a job very like peeling an orange, Hung mentioned.
“Imagine the nerves as the orange peel,” Hung mentioned. “We are trying to separate the peel from the fruit without causing injury or harm and it is a delicate act. This is a procedure we’ve been doing for decades, yet 27% to 81% of patients do not recover their sexual function, so we have room to improve.”
As a result of it takes as a lot as a yr of restoration to know whether or not a affected person’s sexual perform will return, it has been tough for surgeons to attach the dots between actions throughout surgical procedure and a affected person’s final result, Hung mentioned. However robotic procedures, that are routinely recorded for coaching functions, provide a singular alternative to seize a surgeon’s-eye view. And investigators had been in a position to hyperlink use of sure gestures—and avoidance of others—to restoration of sexual perform in sufferers.
“One example is that during a procedure a surgeon might retract or stretch the nerves in order to move them aside, and we found that increased use of retraction was linked with patients’ failure to recover sexual function,” Hung mentioned. “This could be because that pressure causes paralysis of the nerves even though they are physically preserved.”
The investigators’ objective is to construct a library of proof linking surgical gestures to affected person outcomes, finally altering surgical observe and enhancing outcomes.
“Technique is passed down from one generation of surgeons to the next, but without data to back up what mentors are teaching their students,” mentioned Hung, who can be an affiliate professor of Computational Biomedicine. “Until now, we haven’t had the right tools to objectively assess surgical technique. This study is meant to connect the dots between what surgeons do and how well their patients recover.”
There are few surgical efficiency measures that precisely predict affected person outcomes, in accordance with Cristina Ferrone, MD, chair of the Jim and Eleanor Randall Division of Surgical procedure at Cedars-Sinai and interim co-director for Most cancers Medical Providers at Cedars-Sinai Most cancers.
“These findings and future studies that build on this study could eventually change our approach to surgery and training surgeons,” Ferrone mentioned. “By developing a clear understanding of core elements that translate to positive outcomes, it might be possible to improve results for patients across the surgical spectrum.”
Extra data:
John R. Heard et al, Surgical Efficiency Metrics for 1-12 months Affected person-Reported Outcomes After Radical Prostatectomy, JAMA Surgical procedure (2025). DOI: 10.1001/jamasurg.2025.0931
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Cedars-Sinai Medical Heart
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Sure surgical gestures throughout prostate removing linked to raised sexual perform restoration (2025, Could 1)
retrieved 1 Could 2025
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