Effect of learning curve on the perioperative course of robotic-assisted laparoscopic donor nephrectomy compared with laparoscopic donor nephrectomy

Abstract

OBJECTIVE: This study was designed to compare the standard and robotic-assisted laparoscopic donor nephrectomy in terms of perioperative course, short-term postoperative outcome, and to evaluate the effect of surgeon's learning curve on these parameters. METHODS:This was a prospective randomized study including 60 patients (mean age, 47 years; age, 21-72 years; 26 males, 34 females) who had been planned laparoscopic donor nephrectomies in our clinic. For comparison of standard and robot-assisted techniques and to evaluate the impact of learning curve, patients were randomized into three groups by a computer, each group containing 20 patients.Group 1: standard laparoscopic donor nephrectomies; Group 2: the first 20 patients who underwent robot-assisted laparoscopic donor nephrectomy; and Group 3: the next 20 patients who underwent robot-assisted laparoscopic donor nephrectomy.RESULTS: Operative time was significantly higher in Group 2 (221.0±45.1 min) than both Group 1 (183.5±16.9 min, p=0.001) and Group 3 (186.5±20.6 min, p=0.002). Similarly, time for laparoscopic system setup was significantly higher in Group 2 (39.5±8.6 min), which contained the first cases of robot-assisted laparoscopic donor nephrectomy where surgeon had least experience than Group 1 (19.3±3.7 min, p<0.001) and Group 3 (24.0±9.4 min, p<0.001). On the other hand, duration of operation and time for laparoscopic system setup was similar between Groups 1 and 3.CONCLUSIONS: Learning curve extends the operative time and laparoscopic system setup time in robotic-assisted laparoscopic donor nephrectomy, however, after the learning process was completed, these parameters were similar between robotic-assisted and standard laparoscopic nephrectomy.

The learning curve for modified hand-assisted retroperitoneoscopic living donor nephrectomy

“…A randomized controlled trial showed that among surgeons familiar with LDN, transitioning to the robotic-assisted approach appears to have a relatively steep learning curve of 20 cases based on a comparison of the LDN and RALDN procedures. 23 A clinical study suggested that LESS-DN has a long learning curve de ned by the operative time using CUSUM analysis. Speci cally, > 60 cases performed by a surgeon with signi cant clinical experience in laparoendoscopic donor nephrectomy to demonstrate skill in LESS-LDN.…”

Application of robotics in abdominal organ transplantation: A bibliometric analysis

“…3 stronger need for training and growth, there were subsequent publications about the learning curve and training. 40 In the setting of liver transplantation, most of the published data came from centres with extensive experience, unique skill sets, and high volumes of robotic cases. 35,41 The first report of a robotic application on liver transplantation was for right donor hepatectomy, which was documented by the University of Illinois at Chicago group in 2012.…”

“…Most early robotic use in transplantation articles described and demonstrated their feasibility and safety. When there was more experience and a stronger need for training and growth, there were subsequent publications about the learning curve and training 40 …”

Laparoscopic to robotic living donor nephrectomy: Is it time to change surgical technique?

“…Surgeons have frequently described a steep learning curve associated with laparoscopic operations. 19,20 One study of 73 laparoscopic assisted donor nephrectomies showed that as surgeons performed more surgeries, they experienced significantly decreased operative time and improved perioperative graft function. 21 It is possible that the robot assisted technique for live kidney donation has a relatively short learning curve, which contributed to the comparable operative lengths in our treatment groups.…”

“…21 It is possible that the robot assisted technique for live kidney donation has a relatively short learning curve, which contributed to the comparable operative lengths in our treatment groups. 20,22 We plan to further assess the progression of our outcomes in relation to this learning curve in future studies.…”