A novel assessment model for teaching robot-assisted living donor nephrectomy in abdominal transplant surgery fellowship

Abstract

BackgroundAn increasing number of transplant centers have adopted robot-assisted living donor nephrectomy. Thus, a transplant fellow assessment tool is needed for promoting operative independence in an objective and safe manner. MethodsIn this pilot study, data was prospectively collected on both fellow performance with focus on technique, efficiency, and communication (“overall RO-SCORE”), and operative steps (“operative steps RO-SCORE”). Robotic user performance metrics were analyzed from the da Vinci Xi system, including fellow percent active control time (ACT) and handoff counts. ResultsFrom July 2020 to February 2021, twenty-one robot-assisted donor nephrectomies were performed. In regression analysis, fellow performance (based on both RO-SCOREs and robot % ACT) was significantly associated with both time and case number, with time-to-independence modelled at 8.4–14.2 months, and case number-to-independence estimated at 15–22 cases. Robot user metrics provided valid objective measures alongside RO-SCOREs. ConclusionsThis pilot study provides an effective assessment tool for promoting operative competency in robot-assisted donor nephrectomy among transplant fellows.