1857 IMPACT OF THE LEARNING CURVE ON INTRAOPERATIVE AND PERIOPERATIVE OUTCOMES OF ROBOT ASSISTED LAPAROSCOPIC PARTIAL NEPHRECTOMY IN A HIGH-VOLUME RENAL SURGERY CENTER

Abstract

You have accessJournal of UrologyKidney Cancer: Localized1 Apr 20111857 IMPACT OF THE LEARNING CURVE ON INTRAOPERATIVE AND PERIOPERATIVE OUTCOMES OF ROBOT ASSISTED LAPAROSCOPIC PARTIAL NEPHRECTOMY IN A HIGH-VOLUME RENAL SURGERY CENTER Mattia Nicola Sangalli, Giovanni Lughezzani, Alessandro Larcher, Nicolò Buffi, Matteo Zanoni, Emanuele Scapaticci, Giulio Gadda, Andrea Cestari, Massimo Lazzeri, Patrizio Rigatti, Francesco Montorsi, and Giorgio Guazzoni Mattia Nicola SangalliMattia Nicola Sangalli Milan, Italy More articles by this author , Giovanni LughezzaniGiovanni Lughezzani Milan, Italy More articles by this author , Alessandro LarcherAlessandro Larcher Milan, Italy More articles by this author , Nicolò BuffiNicolò Buffi Milan, Italy More articles by this author , Matteo ZanoniMatteo Zanoni Milan, Italy More articles by this author , Emanuele ScapaticciEmanuele Scapaticci Milan, Italy More articles by this author , Giulio GaddaGiulio Gadda Milan, Italy More articles by this author , Andrea CestariAndrea Cestari Milan, Italy More articles by this author , Massimo LazzeriMassimo Lazzeri Milan, Italy More articles by this author , Patrizio RigattiPatrizio Rigatti Milan, Italy More articles by this author , Francesco MontorsiFrancesco Montorsi Milan, Italy More articles by this author , and Giorgio GuazzoniGiorgio Guazzoni Milan, Italy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1904AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The aim of this study is to evaluate the impact of the equipe learning curve on intraoperative and postoperative outcomes of patients treated with Robot-assisted partial nephrectomy (RAPN) at a high-volume renal surgery center. METHODS 58 consecutive patients with a renal mass diagnosed at preoperative CT-scan/MRI underwent a RAPN. Patients data were prospectively collected in our institutional database. Patients were divided into tertiles according to the increasing surgical experience of the robotic-dedicated equipe (surgeon, assistant and scrub-nurse). Intraoperative parameters (operative time [OT], warm ischemia time [WIT], blood loss), perioperative morbidity (classified according the Clavien system) and pathological outcomes (tumor size, histological subtype and surgical margin) were evaluated. Linear regression models explored the relationship between OT, WIT and surgical experience. RESULTS Median tumor size was 30 mm (range 15–55) and median preoperative PADUA score was 8 (range 6–11). Median operative blood loss was 100 mL (range 50–1000). Median WIT and OT were respectively 17 (range 5–30) and 210 (range 90–350) minutes. Median preoperative and postoperative eGFR were respectively 91.6 (range 45.1–197.7) and 91.5 (range 34.9–185.4) ml/min*1.73m2 (p=0.403). The overall complication rate was 22.4%. According to the Clavien classification, most complications were grade I (15.5%), followed by grade II (3.4%), grade IIIa (1.7%) and grade IV (1.7%) complications. Pathological examination revealed malignant histology in 44 (75.9%) patients and benign histology in 14 (24.1%) of patients. Positive surgical margins were observed in 4 (6.9%) patients. After stratification according to surgical experience tertiles, statistically significant differences were observed for median PADUA score (7 vs 8 vs 9; p=0.008), median WIT (18 vs 17 vs 14 minutes; p=0.003), median OT (240 vs 210 vs 180 minutes). Conversely, no statistically significant differences between the three groups were recorded for tumor size (p=0.309), positive surgical margin rate (p=0.795) and overall complication rate (p=0.650). In linear regression models, both WIT (rho 0.467; p<0.001) and OT (rho 0.466; p<0.001) were related to surgical experience. Finally, the learning curve needed to optimize WIT appears to be of 40 cases. CONCLUSIONS RAPN is a feasible option for nephron-sparing surgery in patients diagnosed with renal masses. WIT and OT tend to optimize with increasing robotic-dedicated equipe experience. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e745 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mattia Nicola Sangalli Milan, Italy More articles by this author Giovanni Lughezzani Milan, Italy More articles by this author Alessandro Larcher Milan, Italy More articles by this author Nicolò Buffi Milan, Italy More articles by this author Matteo Zanoni Milan, Italy More articles by this author Emanuele Scapaticci Milan, Italy More articles by this author Giulio Gadda Milan, Italy More articles by this author Andrea Cestari Milan, Italy More articles by this author Massimo Lazzeri Milan, Italy More articles by this author Patrizio Rigatti Milan, Italy More articles by this author Francesco Montorsi Milan, Italy More articles by this author Giorgio Guazzoni Milan, Italy More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...