Impact of the Learning Curve on Perioperative Outcomes in Patients Who Underwent Robotic Partial Nephrectomy for Parenchymal Renal Tumours

Mottrie, Alexandre; Naeyer, Geert De; Schatteman, Peter; Carpentier, Paul; Sangalli, Mattia; Ficarra, Vincenzo

doi:10.1016/j.eururo.2010.03.045

Cited by 239 publications

(182 citation statements)

References 21 publications

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“…23 We used the cut-off of 20 cases, as suggested by Mottrie and colleagues. 24 Other authors have suggested a 25-case experience concerning the WIT. 22,25 Our findings tended to confirm this short learning curve, with rapid improvement of operative parameters and a trend towards lower complication rates.…”

Section: Discussionmentioning

confidence: 99%

Robot-assisted laparoscopic partial nephrectomy: Early single Canadian institution experience

Ploussard

Haddad²,

Kovac³

et al. 2013

CUAJ

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Background: Although robot-assisted partial nephrectomy (RALPN) has been increasingly adopted, open procedures continue to be the reference nephron-sparing technique. We describe our initial surgical outcomes of RALPN in our single institution robotic program. Methods: Between January 2011 and February 2013, 65 consecutive patients underwent a RALPN by 2 surgeons. Preoperative characteristics, including the R.E.N.A.L. nephrometry score, perioperative parameters, and postoperative course, including renal function, were assessed from a retrospective database. The mean follow-up was 12 months. Results: The mean age was 60.2 years and the mean tumour size was 3.9 cm. According to the R.E.N.A.L. nephrometry score, the tumours were classified moderately and highly complex tumours in 51% and 18.5% of cases, respectively. Median warm ischemia time (WIT) was 21 minutes. Factors associated with WIT were R.E.N.A.L. nephrometry score, tumour size, complication rates and surgeon experience. No conversion or grade 4 to 5 complications were reported. The mean hospital stay was 3 days. The overall complication rate was 24.6% (re-admission rate 7.7%), and decreased to 12% after 20 cases. After these initial 20 cases, a trifecta rate (no margins, preserved renal function, no complications) of 64.3% was achieved in moderately and highly complex tumours. The mean change in estimated glomerular filtration rate was 6.7 mL/ min without severe postoperative renal failure. Interpretation: RALPN is a safe and feasible procedure with low specific morbidity, even in moderately or highly complex renal masses. The WIT depends on tumour characteristics, mainly determined by the R.E.N.A.L. nephrometry score and is improved by surgeon experience. Longer follow-up is needed to assess the oncologic mid-term safety of the procedure.

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Section: Discussionmentioning

confidence: 99%

Robot-assisted laparoscopic partial nephrectomy: Early single Canadian institution experience

Ploussard

Haddad²,

Kovac³

et al. 2013

CUAJ

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“…8 To date, numerous preliminary studies on RPN have shown that this technique is comparable to LPN. 9 Although one recent report on the outcomes of RPN compared with OPN has been promising, 10 there are almost no studies that have compared RPN with OPN. We present a single-surgeon comparative study of OPN and RPN in matched patients.…”

Section: Introductionmentioning

confidence: 99%

Comparison of robotic and open partial nephrectomy: Single-surgeon matched cohort study

Byun²,

Hong³

et al. 2014

CUAJ

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Results: There was no significant difference between the 2 cohorts with respect to patient age, BMI, ASA score, preoperative glomerular filtration rate, tumour size and the R.E.N.A.L. nephrometry score. The mean operative time was longer in the RPN group, but there were no significant differences with respect to warm ischemic time and postoperative renal function. The length of hospitalization and use of postoperative analgesics (ketoprofen) were more favourable in the RPN cohort. There was no significant difference in the mean estimated blood loss, transfusion rate, or complications between the cohorts. Conclusions: Considering the perioperative and postoperative parameters, RPN is a viable option as a nephron-sparing surgical procedure for small renal masses that yields outcomes comparable to those achieved with OPN. Despite matched cohort analysis among patients who underwent PN by a single surgeon, there may be inherent selection bias; therefore future prospective trials are needed.

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“…LCs of simple motor tasks can be easily modeled; however, each surgical case is a unique operation with its own set of risks and complications [5]. Assessment of a surgeon's LC is therefore paramount to expose any underlying effects the learning process may have on patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

Robotic partial nephrectomy – Evaluation of the impact of case mix on the procedural learning curve

Roman

Ahmed

Challacombe

2016

International Journal of Surgery

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Impact of the Learning Curve on Perioperative Outcomes in Patients Who Underwent Robotic Partial Nephrectomy for Parenchymal Renal Tumours

Cited by 239 publications

References 21 publications

Robot-assisted laparoscopic partial nephrectomy: Early single Canadian institution experience

Robot-assisted laparoscopic partial nephrectomy: Early single Canadian institution experience

Comparison of robotic and open partial nephrectomy: Single-surgeon matched cohort study

Robotic partial nephrectomy – Evaluation of the impact of case mix on the procedural learning curve

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