A novel assessment model for teaching robot-assisted living donor nephrectomy in abdominal transplant surgery fellowship

Davidson, Jesse T.; Clanahan, Julie M.; Vachharajani, Neeta; Yu, Jennifer; Rice, Teresa C.; Cullinan, Darren R.; Martens, Gregory R.; Olumba, Franklin; Lee, Angela; Matson, Sarah; Scherer, M.; Doyle, Maria B. Majella; Wellen, Jason R.; Khan, Adeel

doi:10.1016/j.amjsurg.2022.09.058

Cited by 6 publications

(11 citation statements)

References 12 publications

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“…This is consistent with observations made previously by our group and others demonstrating an association between an experienced bedside team and improved patient outcomes, such as decreased intraoperative blood loss and shortened length of hospital stay. [6][7][8] A recent report by our group comparing robotic and laparoscopic donor nephrectomies demonstrated comparable safety between the two groups and a significantly shorter postoperative length of stay in the robotic group. 6 Although it is difficult to draw meaningful conclusions on safety without considering all operations and patient selection, at the very least our study suggests that DART facilitates the safe completion of high complexity cases.…”

Section: Discussionmentioning

confidence: 76%

“…11 Unfortunately, given that the field of robotic transplant is very new, its incorporation into fellowship training remains limited and not standardized, leaving many trainees feeling only slightly satisfied with their fellowship robotics experience. 11,12 Training of fellows in robotics has certain unique challenges as it essentially requires two operators: the console surgeon doing the operation and the bedside assistant responsible for instrument exchanges, suctioning, and general troubleshooting. 13 The learning curve for most robotic transplant and HPB surgeries ranges from 20 to 40 cases; therefore, the time spent by the fellows as the console surgeon constitutes a critical aspect of robotic training.…”

Section: Discussionmentioning

confidence: 99%

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The impact of a dedicated operating room team on robotic transplant program growth and fellowship training

Hill,

Scherer,

Kiani

et al. 2023

Clinical Transplantation

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IntroductionDespite considerable interest in robotic surgery, successful incorporation of robotics into transplant programs has been challenging. Lack of a dedicated OR team with expertise in both robotics and transplant is felt to be a major barrier. This paper assesses the impact of a dedicated robotic transplant team (DART) on program growth and fellowship training at one of the largest robotic transplant programs in North America.MethodsThis is a single center, retrospective review of all robotic operations performed on the transplant surgery service from October 2017 to October 2022. DART was incorporated in February 2020 and included transplant first assists (RFAs), scrub technologists and circulating nurses who received robotic training. Robotic experience before and after DART was compared to assess its impact on program growth and training.ResultsFour hundred and two robotic cases were performed by five transplant surgeons: 63 pre‐DART and 339 post‐DART. 40% of cases were transplant‐related and 59.5%, HPB. There was a significant increase in case volume (2.5–10.6 cases/month, p < .0001) and complexity (36.5% vs. 70.3% high complexity cases, p < .0001) post‐DART. RFA case coverage increased from 17% to 95%, and participation of transplant fellows as primary surgeons increased from 17% to 95% post‐DART period (both p < .05). Conversion rates (9.5% vs. 4.1%) and room turn‐around‐times (TAT) (58.4 vs. 40.3 min) were lower post‐DART (p < .05). There were no emergent conversions, conversions in transplant patients, or robot‐related complications in either group.ConclusionOR teams with expertise in robotics and transplant surgery can accelerate growth of robotic transplant programs while maintaining patient safety.

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Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

The impact of a dedicated operating room team on robotic transplant program growth and fellowship training

Hill,

Scherer,

Kiani

et al. 2023

Clinical Transplantation

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…One frequently debated factor is the learning curve experienced by surgeons learning these two techniques. 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 .…”

Section: Discussionmentioning

confidence: 99%

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

Papa

Popović

Loerzel

et al. 2023

Robotics Computer Surgery

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BackgroundWe aimed to explore differences in outcomes of robotic and laparoscopic donor nephrectomies (LDN).MethodsThis study compared robotic and laparoscopic surgical techniques for live donor nephrectomies in 153 patients at a single centre.ResultsLeft nephrectomies were more common in both groups, but with no significant difference between the groups (76.6% vs. 77.6%, p = 0.88). The robotic donor nephrectomies (RDN) group experienced significantly less blood loss (60 vs. 134 mL, p < 0.01), but warm ischaemia time was similar between groups (3.2 vs. 3.7 min, p = 0.54).The RDN group had decreased subjective pain scores (3.54 vs. 4.21, p = 0.04) and shorter length of hospitalisation (2.22 vs. 3.04 days, p < 0.01).There were also fewer complications in the RDN than the LDN group (4 vs. 8, p = 0.186).ConclusionThis study demonstrated that RDN is a safe and alternative to LDN. Decreased blood loss and hospital stays and fewer complications may reflect decreased tissue manipulation with robotic assistance.

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“…14 As the use of robotic assisted techniques have become more common, there has been signi cant interest in the learning curve of this surgical approach and its effects on outcomes. 15 Various studies have de ned the learning curve for RDN as being between 20 and 26 patients, with decreased operative length and improved perioperative outcomes following completion of the learning curve. 16,17 However, none of these studies demonstrated signi cant differences in post-operative outcomes between early RDN cases and those performed subsequent to completion of the learning curve.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Learning Curve on Robotic Living Donor Nephrectomy Outcomes

Papa

Popović

Dvorai

et al. 2023

Preprint

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Background: We aimed to investigate how surgeon experience in different time points impact donors’ outcome. Methods: This is a retrospective study comparing outcome of 77 living kidney donors who had robotic living donor nephrectomies (RDN) performed at a single institution. Donors separated into three groups: 25 patients constituting the learning curve period (LCP), 25 patients constituting the stabilization period (SP), and the 27 patients constituting the teaching period (TP). The groups were compared by collecting data on pre-, intra- and postoperative parameters and costs. Results: Among the three RDN groups, there were significant differences in blood loss (102 mL vs 39 mL vs 41 mL, p=0.01), intra-operative fluids administration (3.2 L vs 3.1 L vs 2.7 L, p=0.45), hospitalization times (2.96 days vs 1.92 days vs 1.85 days, p<0.01), and morphine milligram equivalents (MME) (2068 vs 375 vs 222, p<0.01). Operative time was significantly shorter in the LCP group compared to the TP group (282 min vs 308 min vs 314, p=0.02). However, warm ischemia time was shorter in the TP group compared to the LCP group (5.0 min vs 3.4 min vs 1.5 min, p<0.01). Complication rates were significantly higher in the LCP group compared to the SP and TP groups (p=0.04), but readmission within 30 days was similar at all surgical time points(p=0.58). Surgical costs ($73,756 vs $82,949 vs $91783, p<0.01) were higher in both the SP and TP groups. Conclusion: This study has demonstrated that RDN outcomes improve significantly after the initial learning curve of the technique.

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A novel assessment model for teaching robot-assisted living donor nephrectomy in abdominal transplant surgery fellowship

Cited by 6 publications

References 12 publications

The impact of a dedicated operating room team on robotic transplant program growth and fellowship training

The impact of a dedicated operating room team on robotic transplant program growth and fellowship training

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

The Impact of Learning Curve on Robotic Living Donor Nephrectomy Outcomes

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