Table 3.

Summary of different RARP procedure metric errors and critical errors (CE)^*.

Non completion of the step Non‐sterile technique No communication with the anaesthetist (CE) Using Veress needle Failure to check for port access and instrument access for planned port placement Trauma to mesenteric vessels or omental vessels Damage to inferior epigastric artery Failure to mark port placement appropriately Port site incision too large Ports not placed appropriately Ports not placed perpendicular to skin Inappropriate distance from patient according to the robotic system Failure to check conflict of robotic arms with patient body Incorrect depth of port placement Incorrect energy setting Failure to check assistant access Operating with poor vision Collisions between instruments Trauma to bowel or major vessels (CE) Port damage to bowel or major vessels (CE) Blind insertion of the instruments (CE) Incorrect use of instruments Uncontrolled tearing of tissue Failure to remove loose clips Collisions of the 4th arm Failure to go lateral to the median umbilical ligament Damage to anterior abdominal wall muscle Inadequate tension on the tissues that prevents progress of the dissection Damage to the bladder Diathermy damage to NVB Excessive tension that results in bleeding or trauma to dissection planes Damage the accessory pudendal artery. Failure to control superficial dorsal venous complex Entry to DVC Failure to identify and repair damage to the bladder (CE) Damage to the obturator nerve (CE) Damage to major iliac vessels (CE) Failure to maintain tissue traction Cut into the prostate Buttonhole in the bladder or trigonal damage Excessive bleeding that obscures anatomy Failure to apply traction to the catheter or the prostate Undermined bladder neck Entering adenomectomy plane Excessive traction on bladder neck Plane too cranial that endangers ureteral orifices Failure of traction between prostate and bladder Deep clips that goes into the NVB Damage to ureteral orifices (CE) Damage to ureters (CE) Tearing of the vas deferens or SV Failure to control bleeding from the vas deferens artery Charring of the tissues Neurovascular tissue attached to the SV. Denonvilliers’ fascia attached the SV Damage to the rectum (CE) Damage to NVB NVB is bluntly dissected off prostate inappropriately Inappropriate traction on NVB Inappropriate clips placement Failure to preserve periurethral tissue Failure to stop arterial bleeding Failure to control venous bleeding that compromises visualisation Incorporating urethra in the suture Rupture of the suture Failure to rotate the prostate Progression of the apical dissection with poor visualisation of the anatomy Cut into apical prostatic tissue Sutures placed into rhabdosphincter Cut into rhabdosphincter (CE) Clips placed inappropriately Suture cuts through sphincteric structure Failure to approximate tissues Trauma to urethral stump Trauma to bladder neck Failure to include mucosa in the suture Suture placed into rhabdosphincter inappropriately Suture placed through NVB Suture cutting through the urethra (CE) Suture through ureteral orifices or through ureter (CE) Failure to introduce catheter under direct vision Suturing catheter into the VUA Failure to complete leak test Leakage from the VUA Failure to recognise leakage Failure to correct leakage Rupture of VUA by overfilling the bladder

CE, critical error; DVC, dorsal venous complex; NVB, neurovascular bundle; SV, seminal vesicles; VUA, vesicourethral anastomosis.

^*Some of the errors (e.g., excessive bleeding that obscures anatomy or damage to NVB) are repeated in more than one phase or steps. Consequently, the number of errors reported in the present table is lower than the overall number of errors (n = 145) that can be scored in the evaluation of a full RARP procedure after considering repetitions for each phase or step. The 87 errors (or CE) were unique performance units. These may be repeated for different procedure phases. For example, in phase II, damage to the bladder can occur in steps 18 and 21 and it is explicitly identified as a potential CE for each step.