Robot-Assisted Partial Nephrectomy: Evaluation of Learning Curve for an Experienced Renal Surgeon

Haseebuddin, Mohammed; Benway, Brian M.; Cabello, José M.; Bhayani, Sam B.

doi:10.1089/end.2008.0601

Cited by 92 publications

(61 citation statements)

References 23 publications

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“…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. The literature also suggested that the transition from pure laparoscopic to RALPN may be faster in experienced laparoscopic surgeons.…”

Section: Discussionsupporting

confidence: 60%

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: Discussionsupporting

confidence: 60%

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

Ploussard

Haddad²,

Kovac³

et al. 2013

CUAJ

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“…Scores of [8][9] have been shown to have 14-fold risk and scores > 10 were associated with a 30-fold increase risk of complications compared to those patients reporting scores of 6 to 7 [6].…”

Section: Analyse the Impact Of Case MIX On The Rpn Lcmentioning

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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“…In their recent analysis of 38 consecutive RAPN cases, Haseebuddin et al found that the learning curve was 26 cases with respect to WIT and only 16 cases in regard to total operative time [25]. Surprisingly, parameters such as tumor complexity, intraoperative blood loss, and tumor size did not significantly shape the surgeon's learning curve [25].…”

Section: Learning Curvementioning

confidence: 99%

Robot-assisted partial nephrectomy: current status, techniques, and future directions

Babbar

Hemal

2011

Int Urol Nephrol

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Open partial nephrectomy for the treatment of small renal masses (SRMs) concerning for renal cell carcinoma has been increasingly utilized with the increased incidental detection of SRMs and the growing recognition of the benefits of renal preservation. Laparoscopic partial nephrectomy (LPN) is a minimally invasive technique that achieves comparable oncologic and improved morbidity outcomes when compared to the open procedure. However, LPN is a technically demanding procedure resulting in a long learning curve and a lack of widespread adoption. Robot-assisted partial nephrectomy (RAPN) overcomes many of the technical hurdles of the LPN and is now coming to the forefront for the minimally invasive surgical management of SRMs. To date, the short-term oncologic outcomes of RAPN have been comparable to the open operation while providing the improved morbidity outcomes of LPN. Although encouraging, we await the long-term oncologic results of this new and promising procedure. The current bottleneck is an issue of cost and reliance on a patient-side surgeon. Future developments in instrumentation, newer robots, cost reduction, more streamlined training, increased robotic experience, and adoption by more centers will lead to greater benefit for patients with SRMs requiring nephron-sparing surgery. This review will discuss techniques for RAPN and then delve into the current status of RAPN using parameters such as warm ischemia time, blood loss, hospital stay, oncological outcomes, complications, learning curve, and quality of life. There will be an exploration of potential disadvantages associated with RAPN followed by a look at evolving techniques in regard to this groundbreaking procedure.

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Robot-Assisted Partial Nephrectomy: Evaluation of Learning Curve for an Experienced Renal Surgeon

Cited by 92 publications

References 23 publications

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

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

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

Robot-assisted partial nephrectomy: current status, techniques, and future directions

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