Newswise — LOS ANGELES (April 30, 2025) -- After reviewing hundreds of hours of surgical video, a team led by Cedars-Sinai investigators has created a system that links specific steps performed during a surgical procedure to how well patients recover. The study, published in the peer-reviewed journal , focused on recovery of sexual function following prostate cancer surgery, and investigators say the method could be applied more broadly.
Investigators coined the term surgical gestures to describe the smallest moment-to-moment movements made by a surgeon to complete a procedure.
“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,” said , a urologic surgeon, associate professor of Urology at Cedars-Sinai and senior author of the study. “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 patients undergoing robotic-assisted radical prostatectomy, then followed up to determine whether patients recovered their sexual function one year 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.,” said , chair of the Department of Urology at Cedars-Sinai. “These findings have the potential to change outcomes for tens of thousands of patients each year.”
During these procedures, where the prostate is removed but the nerves responsible for sexual function are preserved, the surgeon is faced with a task much like peeling an orange, Hung said.
“Imagine the nerves as the orange peel,” Hung said. “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.”
Because it takes as much as a year of recovery to know whether a patient’s sexual function will return, it has been difficult for surgeons to connect the dots between actions during surgery and a patient’s outcome, Hung said. But robotic procedures, which are routinely recorded for training purposes, offer a unique opportunity to capture a surgeon’s-eye view. And investigators were able to link use of certain gestures—and avoidance of others—to recovery of sexual function in patients.
“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 said. “This could be because that pressure causes paralysis of the nerves even though they are physically preserved.”
The investigators’ goal is to build a library of evidence linking surgical gestures to patient outcomes, ultimately changing surgical practice and improving results.
“Technique is passed down from one generation of surgeons to the next, but without data to back up what mentors are teaching their students,” said Hung, who is also an associate 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 performance measures that accurately predict patient outcomes, according to , chair of the Jim and Eleanor Randall Department of Surgery at Cedars-Sinai and interim co-director for Cancer Clinical Services at Cedars-Sinai Cancer.
“These findings and future studies that build on this study could eventually change our approach to surgery and training surgeons,” Ferrone said. “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.”
Additional Cedars-Sinai authors include John R. Heard, MD; Umar Ghaffar, MD; and Cherine H. Yang, BA.
Other authors include Runzhuo Ma, MD; Melissa Assel, PhD; Christian Wagner, MD; Geoffrey A. Sonn, MD; Alvin C. Goh, MD; Shady Saikali, MD; Vipul Patel, MD; Andrew Vickers, PhD; and Jim C. Hu, MD.
Funding: This project was supported by a grant from the National Cancer Institute (R01CA273031).
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