MP52-03 THE EUROPEAN EXPERIENCE IN ROBOT-ASSISTED KIDNEY TRANSPLANTATION: LEARNING CURVE

Abstract

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery II (MP52)1 Apr 2020MP52-03 THE EUROPEAN EXPERIENCE IN ROBOT-ASSISTED KIDNEY TRANSPLANTATION: LEARNING CURVE Andrea Gallioli*, Angelo Territo, Romain Boissier, Riccardo Campi, Graziano Vignolini, Mireia Musquera, Antonio Alcaraz, Karel Decaestecker, Volkan Tugcu, Davide Vanacore, Sergio Serni, and Alberto Breda Andrea Gallioli*Andrea Gallioli* More articles by this author , Angelo TerritoAngelo Territo More articles by this author , Romain BoissierRomain Boissier More articles by this author , Riccardo CampiRiccardo Campi More articles by this author , Graziano VignoliniGraziano Vignolini More articles by this author , Mireia MusqueraMireia Musquera More articles by this author , Antonio AlcarazAntonio Alcaraz More articles by this author , Karel DecaesteckerKarel Decaestecker More articles by this author , Volkan TugcuVolkan Tugcu More articles by this author , Davide VanacoreDavide Vanacore More articles by this author , Sergio SerniSergio Serni More articles by this author , and Alberto BredaAlberto Breda More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000914.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robot-assisted kidney transplantation (RAKT) was recently introduced and an ERUS group constituted to draw together early European experiences at the highest volume centers using this minimally invasive technique. Therefore, the aim of the study is to report the learning curve in RAKT, evaluating surgical and functional results in the five highest volume centers of the ERUS group. The second objective of the study is to evaluate the reproducibility of the learning curve. METHODS: All consecutive RAKTs performed in the five highest volume centers of the ERUS RAKT group, i.e. Fundaciò Puigvert and Hospital Clinic (Barcelona), Careggi Hospital (Florence), Ghent University Hospital (Ghent), and Bakirkoy Research Hospital (Istanbul), were reviewed. Shewhart control charts and cumulative summation (CUSUM) graphs were generated to assess the learning curve according to surgical timings and renal graft function (glomerular filtration rate) at days 7, 30 and at 1 year. Linear regressions were performed to compare the learning curves of each surgeon. P values <0.05 were considered statistically significant. The statistical package SPSS V 25 and GraphPad Prism were used. RESULTS: Arterial anastomosis time was below the alarm/alert line in 93.3%/88.9% of RAKTs, while venous anastomosis time was below the alarm/alert line in 88.9%/73.9%. The non-anastomotic rewarming time (RWT) exceeded +3SD in 24.7% of procedures and +2SD in 37.1%. In only 46% cases was the RWT below the alert line. The ureterocystoneostomy time was below +2 and +3SD in 87.9% and 90.2% of cases, respectively. CUSUM showed that the learning curve for arterial anastomosis required up to 35 (mean=16) cases. Complications and delayed graft function rates decreased significantly and reached a plateau after the first 20 cases. A similar conclusion was reached for venous anastomosis, which may need more than 40 procedures (mean=24). The plateau in the ureterocystoneostomy curve was reached within 30 RAKTs in 4/5 centers (mean=17). The plateau for RWT was reached within 23 procedures at center 1, 44 at center 2, and 38 at center 3 (mean 35 cases); centers 4 and 5 did not reach the plateau. Interestingly, the curves for non-anastomotic time during RWT resemble those for RWT. On the linear regression model, all the anastomotic times were comparable. The slopes in respect of non-anastomotic time during RWT were slightly different (p=0.0006), as was also true for RWT itself (p=0.007). CONCLUSIONS: A minimum of 35 cases is necessary to reach reproducibility in terms of anastomosis time, rewarming time and functional results. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e772-e773 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrea Gallioli* More articles by this author Angelo Territo More articles by this author Romain Boissier More articles by this author Riccardo Campi More articles by this author Graziano Vignolini More articles by this author Mireia Musquera More articles by this author Antonio Alcaraz More articles by this author Karel Decaestecker More articles by this author Volkan Tugcu More articles by this author Davide Vanacore More articles by this author Sergio Serni More articles by this author Alberto Breda More articles by this author Expand All Advertisement PDF downloadLoading ...