Evidence map›Paper›PMID 41466133›Full record

ArticleSurgical endoscopy2026

International expert consensus on metric-based characterization of robot-assisted total laparoscopic hysterectomy (RATLH).

Margarita Afonina, Arnold Advincula, Martin Martino, Mireille Truong, David Michelson, Kevin Fogarty, Neil Byerle, Giorgia Gaia, Alexandre Mottrie, Wouter Froyman and 3 more

Abstract readConsensus Statement
PubMed Publisher
In one paragraph

Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Margarita AfoninaOrsi Academy, Melle, Belgium. afoninamargarita@hotmail.com.ORCID http://orcid.org/0000-0002-7126-3866
Arnold AdvinculaDepartment of Obstetrics and Gynaecology, University of Michigan Medical Centre, L 4000 Women's Hospital, Ann Arbor, MI, 48109, USA.
Martin MartinoDepartment of Obstetrics and Gynaecology, Lehigh Valley Health Network, Allentown, PA, USA.
Mireille TruongDivision of Minimally Invasive Gynaecologic Surgery, Department of Obstetrics and Gynaecology, Cedars-Sinai Medical Centre, Los Angeles, CA, USA.
David MichelsonMedical Education, Medtronic Surgical Robotics, New York, NY, USA.
Kevin FogartyMedical Education, Medtronic Surgical Robotics, New York, NY, USA.
Neil ByerleMedical Education, Medtronic Surgical Robotics, New York, NY, USA.
Giorgia GaiaFondazione Policlinico A. Gemelli IRCSS, Rome, Italy.
Alexandre MottrieOrsi Academy, Melle, Belgium.
Wouter FroymanDepartment of Obstetrics and Gynaecology, University Hospitals KU Leuven, Louvain, Belgium.
Ben Van CleynenbreugelOrsi Academy, Melle, Belgium.
Anthony G GallagherOrsi Academy, Melle, Belgium.
RATLH-Delphi Surgeons Group

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

STUDY

objectiveThe study aimed to develop procedural performance metrics for robot-assisted total laparoscopic hysterectomy (RATLH) and to establish face and content validity through a Delphi consensus meeting.

designA core metrics team comprising three highly experienced gynaecologists in RATLH and a behavioural scientist developed the metrics.

settingTwo modified Delphi consensus meetings took place as a face-to-face and online. PATIENTS: The final metrics were discussed by 28 experts in RATLH from 13 different countries.

interventionsThe core metrics team performed a detailed task deconstruction of the RATLH procedure. To ensure a comprehensive representation of technique and clinical practice across both the US and Europe, a consensus meeting was also conducted with European clinicians. MEASUREMENTS AND MAIN

resultsInitially, performance metrics consisting of 20 Phases, 110 steps, 119 errors, and 54 critical errors were identified to characterize the RATLH procedure. During the Delphi meetings, these were discussed and modified. The outcome of the meeting was consensus on 20 Phases of the procedure, with 116 Steps (8 added, 2 deleted), 134 Errors (19 were added and 4 were deleted), and 56 Critical Errors (2 added). A total number of 41 general edits were performed with 100% consensus.

conclusionsThis study presents the first comprehensive metric-based characterization of a standardized approach to RATLH, validated by expert consensus using a structured methodology that comprises operative procedure Steps, Errors, and Critical Errors. The next phase will evaluate reliability and the construct validity of the agreed metrics.

Indexed as

HysterectomyLaparoscopyRobotic Surgical ProceduresClinical CompetenceDelphi TechniqueFemaleHumansProficiency-based trainingRobot-assisted total laparoscopic hysterectomySurgical training

Identifiers

PMID41466133

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.