PD49-02 ROBOTIC PARTIAL NEPHRECTOMY VERSUS LAPAROSCOPIC PARTIAL NEPHRECTOMY: COMPARISON OF THE LEARNING CURVES

Abstract

You have accessJournal of UrologyKidney Cancer: Surgical Therapy VI1 Apr 2015PD49-02 ROBOTIC PARTIAL NEPHRECTOMY VERSUS LAPAROSCOPIC PARTIAL NEPHRECTOMY: COMPARISON OF THE LEARNING CURVES Benoit peyronnet, Damien chaste, Zineddine khene, Romain mathieu, Gregory verhoest, and Karim bensalah Benoit peyronnetBenoit peyronnet More articles by this author , Damien chasteDamien chaste More articles by this author , Zineddine kheneZineddine khene More articles by this author , Romain mathieuRomain mathieu More articles by this author , Gregory verhoestGregory verhoest More articles by this author , and Karim bensalahKarim bensalah More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2720AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To date, the main advantage of robot-assisted partial nephrectomy (RAPN) compared to laparoscopic partial nephrectomy (LPN) that has been shown in the literature is a decreased warm ischemia time. Another potential benefit may be a shorter learning curve for RAPN. The objective of this study was to compare the learning curves LPN and RAPN. METHODS Data from the first 40 LPN and the first 120 RAPN of a single-surgeon (surgeon nO 1) and those from the first 40 RAPN of another surgeon (surgeon nO 2) were retrospectively collected. The second surgeon had no experience of LPN but trained by the expert surgeon and applying the standardised technique of the latter. The primary endpoint was the achievement of TRIFECTA defined by a warm ischemia time ≤ 25 minutes warm ischemia associated with negative surgical margins and no perioperative complications. The RAPN were divided into groups of 10 cases in chronological order. Pre, per and post-operative data were then compared between groups. RESULTS Since their first robotic cases (RAPN 1 to 10) the results of surgeons 1 and 2 were similar to those obtained after an experience > 30 laparoscopic cases (LPN 30-40) in terms of postoperative complications (50% vs. 40% vs. 30%, p = 0.66), positive margins (0% vs. 10% vs. 10%, p = 0.58) or operative time (186 min vs. 192 vs. 176, p = 0.7). In the group of RAPN performed by the surgeon n° 1, there was no statistically significant improvement of RENAL SCORE and tumor size after 30 procedures; or of warm ischemia time (mean < 20 minutes) and achievement of the TRIFECTA (≥ 60%) after 20 procedures. The operative time and post-operative complications became stable after 90 procedures. From his first cases, an optimal result was obtained for the surgical margins (0 % of positive surgical margins). CONCLUSIONS This is the first study to assess that the learning curve of the RAPN is shorter than the learning curve of LPN even for a laparoscopically naive surgeon subject to appropriate training by an experienced surgeon and to implementation of a standardised technique. Most of the perioperative outcomes did not improve significantly after 30 cases and this threshold could be considered as the learning curve for RAPN. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e971 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Benoit peyronnet More articles by this author Damien chaste More articles by this author Zineddine khene More articles by this author Romain mathieu More articles by this author Gregory verhoest More articles by this author Karim bensalah More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...