Mp48-04 Robotic-Assistance Is Associated With Improved Perioperative Outcomes in Minimally-Invasive Radical Nephrectomy

Abstract

INTRODUCTION AND OBJECTIVES: Robot-assisted partial nephrectomy [RAPN] is a complex procedure and surgical outcomes can be influenced by increasing surgical experience [EXP]. The aim of the study is to investigate the effect of EXP on perioperative outcomes to define the surgical learning curve for RAPN, since actual curves are rarely presented.METHODS: 457 patients treated with RAPN for a cT1-2 renal mass by two surgeons with extensive EXP (>300 cases) were assessed into a prospective database were. For each patient, EXP was defined as the total number of RAPN performed by each surgeon before the patient's operation. Outcomes of the study were warm ischemia time [WIT], Clavien-Dindo 2 postoperative complications [CD2] and positive surgical margins [PSM]. Multivariable linear (WIT) and logistic regression (CD2, PSM) models tested the effect of EXP on the outcomes. Restricted cubic splines were used to test for the non-linear nature of the relationship between EXP and the outcomes. Covariates consisted of tumour clinical size and RENAL nephrometry score to account for case mix. Local polynomial smoothing method was used to depict actual curves using model-derived estimated WIT and probability of CD2-free postoperative course.RESULTS: Median EXP was 148 cases (interquartile range [IQR] 65-254). Median WIT was 14 min (IQR 10-19). The rate of CD2 and PSM were 14 and 4%, respectively. Increasing EXP resulted associated with lower ischemia time (1st spline estimate -4.5 minutes per 25 cases; 95% confidence intervals [CI] -2.3,-1.3; p<0.0001) and with higher probability of CD2-free postoperative course (OR 1.01 per 25 cases; CI:1.005,1.02; p<0.001). Conversely, EXP was not associated with PSM (OR 1.00; CI 0.99,1.002; p¼0.5). The relationship between EXP and WIT resulted non-linear, with a steep reduction in WIT from case 1 to case 100 and a plateau observed after 150 cases (Figure 1 panel A). Conversely, the relationship between EXP and CD2 resulted linear without a plateau being observed even after 300 cases (Figure 1 panel B).CONCLUSIONS: Perioperative outcomes after RAPN are importantly affected by surgical experience. After 150 RAPNs, no further improvement is observed with respect to WIT. Conversely, when CD2 are taken into considerations, the learning curve appears endless, without a plateau even after 300 cases.

Case report: robot-assisted extended radical nephrectomy with removal of conglomerate of the lymph nodes

“…Минимальная инвазивная радикальная нефрэктомия ассоциируется со снижением количества осложнений, меньшей кровопотерей и более коротким сроком госпитализации [4,5].…”

“…По данным Rodriguez J, et al (2018), при сравнении лапароскопической и робот-ассистированной радикальной нефрэктомии последняя была связана с меньшей частотой конверсий, меньшей длительностью операции и меньшей частотой регоспитализаций в стационар. Однако разница между этими показателями составляла менее 5 % [4].…”