MP47-03 IS THERE A LEARNING CURVE PLATEAU FOR ACHIEVING TRIFECTA AND MINIMIZING OPERATIVE TIME (OT) FOR ROBOTIC-ASSISTED PARTIAL NEPHRECTOMY (RAPN)?

Abstract

You have accessJournal of UrologySurgical Technology & Simulation: Training & Skills Assessment II (MP47)1 Apr 2020MP47-03 IS THERE A LEARNING CURVE PLATEAU FOR ACHIEVING TRIFECTA AND MINIMIZING OPERATIVE TIME (OT) FOR ROBOTIC-ASSISTED PARTIAL NEPHRECTOMY (RAPN)? Essa M. Bajalia*, Kevin A. Parikh, Daniela A. Haehn, Amanda E. Kahn, Colleen T. Ball, and David D. Thiel Essa M. Bajalia*Essa M. Bajalia* More articles by this author , Kevin A. ParikhKevin A. Parikh More articles by this author , Daniela A. HaehnDaniela A. Haehn More articles by this author , Amanda E. KahnAmanda E. Kahn More articles by this author , Colleen T. BallColleen T. Ball More articles by this author , and David D. ThielDavid D. Thiel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000902.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The complexities of RAPN can lead to a steep learning curve. We assessed the surgical learning curve and plateau point for achieving trifecta and minimizing OT in RAPN. METHODS: We evaluated 418 consecutive RAPN from a fellowship trained robotic surgeon between February 2008 and April 2019. The cases were separated into increments of 50. Cases were excluded from analysis if the patient had a prior RAPN performed at our institution (7 cases), if the patient was treated for calyceal diverticulum (4 cases), or if it was classified as a combo case (1 case). Trifecta was defined as warm ischemia time <25 minutes, negative surgical margins, and no grade 3 or higher postoperative complications. For the primary analysis we explored the correlation between surgical case number and patient outcomes using the Kendall correlation test. Age, sex, body mass index, tumor size, Mayo Adhesive Probability score, and R.E.N.A.L. score were all adjusted for as potential confounding variables in the spline regression methods. All statistical tests were two-sided. P values < 0.05 were considered statistically significant. RESULTS: Among the 406 eligible patients included in the study, 252 (62.1%) were male, median age was 63 years (range, 22 to 84), and median body mass index was 29 kg/m2 (IQR 26, 33). 272 patients achieved trifecta and average OT was 200 minutes. We found that RAPN experience (higher case number) was associated with shorter OT (P<0.001). OT (minutes) for the case increments were as follows: 1-50 (222.3±43.6), 51-100 (204.1±47.2), 101-150 (202.1±30.2), 151-200 (201.7±35.3), 201-250 (196.5±46.0), 251-300 (188.2±37.6), 301-350 (194.0±40.7), and 401-418 (186.1±40.4). Trifecta achievement for the increments were as follows: 1-50 (63%), 51-100 (82%), 101-150 (66%), 151-200 (67%), 201-250 (54%), 251-300 (71%), 301-350 (84%), 351-400 (74%), and 401-418 (72%). Although we did not find statistically significant overall increasing or decreasing trends in trifecta with surgeon experience, the restricted cubic spline logistic regression suggests peak performance with slightly under 100 cases (Figure 1). CONCLUSIONS: Maximizing OT performance and achievement of trifecta in RAPN appears to occur at a learning curve of about 100 cases. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e684-e684 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Essa M. Bajalia* More articles by this author Kevin A. Parikh More articles by this author Daniela A. Haehn More articles by this author Amanda E. Kahn More articles by this author Colleen T. Ball More articles by this author David D. Thiel More articles by this author Expand All Advertisement PDF downloadLoading ...