Abstract
To provide perioperative benchmark data for surgeons entering practice from formal robotic training and performing robotic-assisted laparoscopic partial nephrectomy (RAPN). Perioperative outcomes of the first 100 RAPN from a surgeon entering into practice directly from robotic fellowship training were analyzed. Postoperative complications were categorized by Clavien-Dindo grade. Surgical “trifecta scores” and Margin, Ischemia, and Complication (MIC) scoring were utilized to assess surgical outcomes. Statistical analyses were performed using SAS (version 9.2; SAS Institute, Inc., Cary, North Carolina). Median age of the cohort was 63 years (22–81 years), and 34 (34.3 %) patients were over age 65. Forty-one (41.4 %) patients had a BMI > 30. Thirteen (13.1 %) had RENAL 10–12 tumors, 22 of which (22.2 %) were >4 cm in size. Median warm ischemia time was 17 min, and 13 patients had resection without warm ischemia. Five patients were converted to open partial nephrectomy, and 1 patient was converted to laparoscopic nephrectomy. Twenty-one patients (21.2 %) experienced a complication, 6 of whom had a major (Clavien grade 3 or higher) complication with one grade 5 complication. Operating room time decreased with experience, but surgical complications and hospital stay did not change with experience. MIC score of renal cell carcinoma (RCC) patients was 74.7 %, while the surgical trifecta was reached in 71.3 % of RCC patients. Surgeons may enter practice directly from formal robotic training and perform RAPN with perioperative outcomes, surgical complications, surgical trifecta scores, and MIC scoring in line with those the most experienced robotic partial nephrectomists.
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References
Hollenbeck BK, Taub DA, Miller DC, Dunn RL, Wei JT (2006) National utilization trends of partial nephrectomy for renal cell carcinoma: a case of underutilization? Urology 67:254–259. doi:10.1016/j.urology.2005.08.050
Poon SA, Silberstein JL, Chen LY, Ehdaie B, Kim PH, Russo P (2013) Trends in partial and radical nephrectomy: an analysis of case logs from certifying urologists. J Urol 190:464–469. doi:10.1016/j.juro.2013.02.094
Tanagho YS, Kaouk JH, Allaf ME, Rogers CG, Stifelman MD, Kaczmarek BF, Hillyer SP, Mullins JK, Chiu Y, Bhayani SB (2013) Perioperative complications of robot-assisted partial nephrectomy: analysis of 886 patients at 5 United States centers. Urology 81:573–580. doi:10.1016/j.urology.2012.10.067
Spana G, Haber GP, Dulabon LM, Petros F, Rogers CG, Bhayani SB, Stifelman MD, Kaouk JH (2011) Complications after robotic partial nephrectomy at centers of excellence: multi-institutional analysis of 450 cases. J Urology 186:417–422. doi:10.1016/j.juro.2011.03.127
Ficarra V, Bhayani S, Porter J, Buffi N, Lee R, Cestari A, Mottrie A (2012) Predictors of warm ishcemia time and peri-operative complications in a multicenter, international series of robot-assisted partial nephrectomy. Euro Urol 61:395–402. doi:10.1016/j.eururo.2011.10.046
Bhayani SB, Figenshau RS (2008) The Washington University Rennorrhaphy for robotic parital nephrectomy: a detailed description of the technique displayed at the 2008 World Robotic Urologic Symposium. J Robot Surg 2:139–140
Simmons MN (2011) Morphometric characterization of kidney tumors. Curr Opin Urol 21:99–103. doi:10.1097/MOU.0b013e32834208d6
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications. Ann Surg 240:205–213
Hung HJ, Cai J, Simmons MN, Gill IS (2013) “Trifecta” in partial nephrectomy. J Urol 189:36–42. doi:10.1016/j.juro.2012.09.042
Buffi N, Lista G, Larcher A, Lughessani G, Ficarra V, Cestari A, Lazzeri M, Guazzoni G (2012) Margin, ischemia, and complications (MIC) score in partial nephrectomy: a new system for evaluating achievement of optimal outcomes in nephron-sparing surgery. Euro Urol 62:617–619. doi:10.1016/j.eururo.2012.06.001
Mottire A, Naeyer GD, Schatteman P, Carpentier P, Sangalli M, Ficarra V (2010) Impact of the learning curve on perioperative outcomes in patients who underwent robotic partial nephrectomy fo parenchymal renal tumours. Euro Urol 58:127–133. doi:10.1016/j.eururo.2010.03.045
Haseebuddin M, Benway BM, Cabello JM, Bhayani SB (2010) Robot-assisted partial nephrectomy: evaluation of learning curve for an experienced renal surgeon. J Endourol 24(1):57–61. doi:10.1089/end.2008.0601
Mathieu R, Werhoest G, Droupy S, de la Taille A, Bruyere F, Doumerc N, Rischmann P, Vaessen C, Roupret M, Bensalah K (2013) Predictive facors of complications after robot-assisted laparoscopic partial nephrectomy: a retrospective multicentre study. BJU Int 112:283–289. doi:10.1111/bju.12222
Kim EH, Larson JA, Fienshau M, Figenshau RS (2014) Perioperative complications of robot-assisted partial nephrectomy. Curr Urol Rep 15:377. doi:10.1007/s11934-013-0377-y
Fardoun T, Chaste D, Oger E, Mathieu R, Peyronnet B, Rioux-Leclercq N, Verhoest G, Patard JJ, Bensalah K (2014) Predictive factors of hemorrhagic complications after partial nephrectomy. Eur J Surg Oncol 40:85–89. doi:10.1016/j.ejso.2013.11.006
Becker F, Van Poppel H, Hakenberg OW, Steif C, Gill I, Guazzoni G, Montorsi F, Russo P, Stockle M (2009) Assessing the impact of ischemia time during partial nephrectomy. Eur Urol 56:625. doi:10.1016/j.eururo.2009.07.016
Ghani KR, Sukumar S, Sammon JD, Rogers CG, Trinh QD, Menon M (2014) Practice patterns and outcomes of open and minimally invasive partial nephrectomy since the introduction of robotic partial nephrectomy: results from the nationwide inpatient sample. J Urol 191(4):907–913. doi:10.1016/j.juro.2013.10.099
Ellison JS, Montogmery JS, Wolf JS, Hafez KS, Miller DC, Weizer AZ (2012) A matched comparison of perioperative outcomes of a single laparoscopic surgeon versus a multisurgeon robot-assited cohort for partial nephrecotmy. J Urol 188:45–50. doi:10.1016/j.juro.2012.02.2570
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AST, BL, and BR have nothing to disclose. DDT is a consultant for Cooper Surgical Corporation.
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This review was approved by the Mayo Clinic Institutional Review Board. All procedures performed were in accordance with the ethical standards of the above review board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this retrospective review of prospectively collected de-identified data, formal individual patient consent was not required.
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Taylor, A.S., Lee, B., Rawal, B. et al. Impact of fellowship training on robotic-assisted laparoscopic partial nephrectomy: benchmarking perioperative safety and outcomes. J Robotic Surg 9, 125–130 (2015). https://doi.org/10.1007/s11701-015-0498-z
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DOI: https://doi.org/10.1007/s11701-015-0498-z