Impact of Surgical Experience Before Robot-assisted Partial Nephrectomy on Surgical Outcomes: A Multicenter Analysis of 2500 Patients.
Learning curve
Renal cell carcinoma
Robot-assisted partial nephrectomy
Robot-assisted surgery
Surgical experience
Journal
European urology open science
ISSN: 2666-1683
Titre abrégé: Eur Urol Open Sci
Pays: Netherlands
ID NLM: 101771568
Informations de publication
Date de publication:
Dec 2022
Dec 2022
Historique:
accepted:
04
10
2022
entrez:
12
12
2022
pubmed:
13
12
2022
medline:
13
12
2022
Statut:
epublish
Résumé
Robot-assisted partial nephrectomy (RAPN) is a challenging procedure that is influenced by a multitude of factors. To assess the impact of prior surgical experience on perioperative outcomes in RAPN. In this retrospective multicenter study, results for 2548 RAPNs performed by 25 surgeons at eight robotic referral centers were analyzed. Perioperative data for all consecutive RAPNs from the start of each individual surgeon's experience were collected, as well as the number of prior open or laparoscopic kidney surgeries, pelvic surgeries (open, laparoscopic, robotic), and other robotic interventions. Transperitoneal or retroperitoneal RAPN. The impact of prior surgical experience on operative time, warm ischemia time (WIT), major complications, and margin, ischemia, complication (MIC) score (negative surgical margins, WIT ≤20 min, no major complications) was assessed via univariate and multivariable regression analyses accounting for age, gender, body mass index (BMI), American Society of Anesthesiologists score, PADUA score, and RAPN experience. BMI, PADUA score, and surgical experience in RAPN had a strong impact on perioperative outcomes. A plateau effect for the learning curve was not observed. Prior laparoscopic kidney surgery significantly reduced the operative time ( Mastering of RAPN is an ongoing learning process. However, prior experience in laparoscopic kidney and robot-assisted pelvic surgery seems to improve perioperative outcomes for surgeons when starting with RAPN, while experience in open surgery might not be crucial. In this multicenter analysis, we found that a high degree of experience in keyhole kidney surgery and robot-assisted pelvic surgery helps surgeons in achieving good initial outcomes when starting robot-assisted kidney surgery.
Sections du résumé
Background
UNASSIGNED
Robot-assisted partial nephrectomy (RAPN) is a challenging procedure that is influenced by a multitude of factors.
Objective
UNASSIGNED
To assess the impact of prior surgical experience on perioperative outcomes in RAPN.
Design setting and participants
UNASSIGNED
In this retrospective multicenter study, results for 2548 RAPNs performed by 25 surgeons at eight robotic referral centers were analyzed. Perioperative data for all consecutive RAPNs from the start of each individual surgeon's experience were collected, as well as the number of prior open or laparoscopic kidney surgeries, pelvic surgeries (open, laparoscopic, robotic), and other robotic interventions.
Intervention
UNASSIGNED
Transperitoneal or retroperitoneal RAPN.
Outcome measurements and statistical analysis
UNASSIGNED
The impact of prior surgical experience on operative time, warm ischemia time (WIT), major complications, and margin, ischemia, complication (MIC) score (negative surgical margins, WIT ≤20 min, no major complications) was assessed via univariate and multivariable regression analyses accounting for age, gender, body mass index (BMI), American Society of Anesthesiologists score, PADUA score, and RAPN experience.
Results and limitations
UNASSIGNED
BMI, PADUA score, and surgical experience in RAPN had a strong impact on perioperative outcomes. A plateau effect for the learning curve was not observed. Prior laparoscopic kidney surgery significantly reduced the operative time (
Conclusions
UNASSIGNED
Mastering of RAPN is an ongoing learning process. However, prior experience in laparoscopic kidney and robot-assisted pelvic surgery seems to improve perioperative outcomes for surgeons when starting with RAPN, while experience in open surgery might not be crucial.
Patient summary
UNASSIGNED
In this multicenter analysis, we found that a high degree of experience in keyhole kidney surgery and robot-assisted pelvic surgery helps surgeons in achieving good initial outcomes when starting robot-assisted kidney surgery.
Identifiants
pubmed: 36506259
doi: 10.1016/j.euros.2022.10.003
pii: S2666-1683(22)02043-2
pmc: PMC9732453
doi:
Types de publication
Journal Article
Langues
eng
Pagination
45-52Informations de copyright
© 2022 The Author(s).
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