Three Different Learning Curves Have an Independent Impact on Perioperative Outcomes After Robotic Partial Nephrectomy: A Comparative Analysis

Abstract

Background Robot-assisted partial nephrectomy (RAPN) has become widely accepted, but its different underlying types of learning curves have not been comparatively analyzed to date. This study aimed to determine and compare the impact that the learning curve of the department, the console surgeon, and the bedside assistant as well as patient-related factors has on the perioperative outcomes of RAPN. Methods The study retrospectively analyzed 500 consecutive transperitoneal RAPNs (2007–2018) performed in a tertiary referral center by 7 surgeons and 37 bedside assistants. Patient characteristics and surgical data were obtained. Experience (EXP) was defined as the current number of RAPNs performed by the department, the surgeon, and the assistant. As the primary outcome, the impact of EXP and patient-related factors on perioperative outcomes were analyzed and compared. As the secondary outcome, a cutoff between “experienced” and “inexperienced” was defined. Correlation and regression analysis, receiver operating characteristic curve analysis, Fisher’s exact test, and the Mann–Whitney U test were performed, with p values lower than 0.05 denoting significance. Results The EXP of the department, the surgeon, and the assistant each has a major influence on perioperative outcome in RAPN irrespective of patient-related factors. Perioperative outcomes improve significantly with EXP greater than 100 for the department, EXP greater than 35 for the surgeon, and EXP greater than 15 for the assistant. Conclusions The perioperative results of RAPN are influenced by three different types of learning curves including those for the surgical department, the console surgeon, and the assistant. The influence of the bedside assistant clearly has been underestimated to date because it has a significant impact on the perioperative outcomes of RAPN. Electronic supplementary material The online version of this article (10.1245/s10434-020-08856-1) contains supplementary material, which is available to authorized users.

Open versus robot‐assisted partial nephrectomy: A longitudinal comparison of 880 patients over 10 years

“…In contrast to OPN, where the surgical results remained stable, RAPN clearly showed an inherent learning curve: MIC rates increased (54.5%–66.4%) while operating time (172–152 min), WIT (18–13 min), and length of stay (7–6 days) further decreased (for all p < 0.05). At the same time, tumors became more complex, and mid‐ and high‐risk tumors were operated on to a greater extent (see Table ) 37 …”

Robot‐assisted versus open radical cystectomy: A cohort study on perioperative outcomes accounting for stage selection bias and surgical experience

“…Data acquisition was performed by reviewing the individual medical records. The robotic surgeons were consultants and experienced in all other urologic robotic interventions, including at least 50–100 radical prostatectomies, (partial) nephrectomies or pyeloplasties 21,22 . They performed RARC as previously described 23 .…”

“…The robotic surgeons were consultants and experienced in all other urologic robotic interventions, including at least 50-100 radical prostatectomies, (partial) nephrectomies or pyeloplasties. 21,22 They performed RARC as previously described. 23 Neobladders were performed in the 'W'shaped technique by Hautmann, irrespective of the surgical approach.…”

Roboter-assistierte Chirurgie des Nierenzellkarzinoms – heute ein Standard?

“…Anfänglich niedrigere Raten an off-clamp Exzisionen oder eine längere WIZ bei RANT wurden mit steigender Erfahrung der Operateure ausgeglichen. Letztlich hatte aber nicht nur die Erfahrung des Operateurs, sondern auch die des Bed-Side Assistenten einen signifikanten Einfluss auf die operativen Ergebnisse [39]. Der Einfluss des Assistenten auf die operativen Ergebnisse von RANT war zuvor deutlich unterschätzt worden.…”