Identifying Preoperative Predictors of Operative Time and Their Impact on Outcomes in Robot-Assisted Partial Nephrectomy

Krishnan, Naveen; Zappia, Jason; Calaway, Adam; Nagle, Ramzy T.; Sundaram, Chandru P.; Boris, Ronald S.

doi:10.1089/end.2021.0075

Cited by 7 publications

(5 citation statements)

References 33 publications

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“…Our findings add to a collection of recent studies on RAPN that have shown increased operative time for high complexity cases, as indicated by an increasing nephrometry score [ 14 ]. Okhawere et al reported shorter operative times in an SP cohort compared to an MP cohort for high complexity (nephrometry score = 10–12) renal masses, as well as shorter operative times in a high complexity SP group compared to low and intermediate complexity SP groups [ 15 ].…”

Section: Discussionsupporting

confidence: 73%

Single-port vs multi-port robot-assisted renal surgery: analysis of perioperative outcomes for excision of high and low complexity renal masses

et al. 2023

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There is emerging but limited data assessing single-port (SP) robot-assisted surgery as an alternative to multi-port (MP) platforms. We compared perioperative outcomes between SP and MP robot-assisted approaches for excision of high and low complexity renal masses. Retrospective chart review was performed for patients undergoing robot-assisted partial or radical nephrectomy using the SP surgical system ( n = 23) at our institution between November 2019 and November 2021. Renal masses were categorized as high complexity (7+) or low complexity (4–6) using the R.E.N.A.L. nephrometry scoring system. Adjusting for baseline characteristics, patients were matched using a prospectively maintained MP database in a 2:1 (MP:SP) ratio. For high complexity tumors ( n = 12), SP surgery was associated with a significantly longer operative time compared to MP (248.4 vs 188.1 min, p = 0.02) but a significantly shorter length of stay (1.9 vs 2.8 days, p = 0.02). For low complexity tumors ( n = 11), operative time (177.7 vs 161.4 min, p = 0.53), estimated blood loss (69.6.0 vs 142.0 mL, p = 0.62), and length of stay (1.6 vs 1.8 days, p = 0.528) were comparable between SP and MP approaches. Increasing nephrometry score was associated with a greater relative increase in operative time for SP compared to MP renal surgery ( p = 0.07) using best of fit linear modeling. SP robot-assisted partial and radical nephrectomy is safe and feasible for low complexity renal masses. For high complexity renal masses, the SP system is associated with a significantly longer operative time compared to the MP technique. Careful consideration should be given when selecting patients for SP robot-assisted kidney surgery.

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Section: Discussionsupporting

confidence: 73%

Single-port vs multi-port robot-assisted renal surgery: analysis of perioperative outcomes for excision of high and low complexity renal masses

et al. 2023

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“…Our ndings add to a collection of recent studies on RAPN that have shown increased operative time for high complexity cases, as indicated by an increasing nephrometry score [14]. Okhawere et al reported shorter operative times in an SP cohort compared to an MP cohort for high complexity (nephrometry score = 10-12) renal masses, as well as shorter operative times in a high complexity SP group compared to low and intermediate complexity SP groups [15].…”

Section: Discussionsupporting

confidence: 64%

Single-port Vs Multi-port Robot-assisted Renal Surgery: Analysis of Perioperative Outcomes for Excision of High and Low Complexity Renal Masses

Berry

Hill

Vetter

et al. 2023

Preprint

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There is emerging but limited data assessing single-port (SP) robot-assisted surgery as an alternative to multi-port (MP) platforms. We compared perioperative outcomes between SP and MP robot-assisted approaches for excision of high and low complexity renal masses. Retrospective chart review was performed for patients undergoing robot-assisted partial or radical nephrectomy using the SP surgical system (n = 23) at our institution between November 2019 and November 2021. Renal masses were categorized as high complexity (7+) or low complexity (4–6) using the R.E.N.A.L. nephrometry scoring system. Adjusting for baseline characteristics, patients were matched using a prospectively maintained MP database in a 2:1 (MP:SP) ratio. For high complexity tumors (n = 12), SP surgery was associated with a significantly longer operative time compared to MP (248.4 vs 188.1 min, p = 0.02) but a significantly shorter length of stay (1.9 vs 2.8 days, p = 0.02). For low complexity tumors (n = 11), operative time (177.7 vs 161.4 min, p = 0.53), estimated blood loss (69.6.0 vs 142.0 mL, p = 0.62), and length of stay (1.6 vs 1.8 days, p = 0.528) were comparable between SP and MP approaches. Increasing nephrometry score was associated with a greater relative increase in operative time for SP compared to MP renal surgery (p = 0.07) using best of fit linear modeling. SP robot-assisted partial and radical nephrectomy is safe and feasible for low complexity renal masses. For high complexity renal masses, the SP system is associated with a significantly longer operative time compared to the MP technique. Careful consideration should be given when selecting patients for SP robot-assisted kidney surgery.

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“…OT is a critical factor, as it not only affects patient outcomes but also has implications for resource utilization and the efficiency of surgery. While concerns exist regarding the potential drawbacks of increased operative duration, such as increased anesthesia exposure and longer LOS [10], extended OT did not lead to a higher rate of perioperative complications according to our results. Similar data have been reported in studies assessing the impact of the level of assistant experience on other urological minimally invasive surgical procedures.…”

Section: Discussionsupporting

confidence: 43%

“…The potential risks associated with having less experienced assistants in the operating room, such as longer operative times [7,8], negative impacts on patient outcomes [9][10][11], and increased risk of surgical complications [11], highlight the importance of understanding the dynamics of resident involvement in laparoscopic nephrectomy. Evidence of the actual impact of resident expertise on surgical outcomes of laparoscopic radical or simple nephrectomy is lacking in the literature.…”

Section: Introductionmentioning

confidence: 99%

Impact of Assistant Experience on Perioperative Outcomes of Simple and Radical Laparoscopic Nephrectomy: Does It Really Matter?

Ambrosini,

Mantica,

Marchi

et al. 2023

Medicina

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Background and Objectives: While systematic reviews highlight the advantages of laparoscopic nephrectomy over traditional open surgery, the impact of an assistant’s experience on surgical outcomes remains unclear. This study aims to evaluate whether the level of assistant expertise influences laparoscopic nephrectomy outcomes. Materials and Methods: Retrospective data from our institutional database were analyzed for patients who underwent laparoscopic nephrectomy between January 2018 and December 2022. Procedures were performed by a highly experienced surgeon, including postgraduate year (PGY)-3 to PGY-5 residents as assistants. Senior-level assistants had completed at least 10 procedures. Patient characteristics, surgical outcomes, and postoperative details were collected. Multivariable linear and logistic regression models were performed to test the effect of assistant experience (low vs. high) on estimated blood loss (EBL), length of stay (LOS), operative time (OT), and postoperative complications. Results: 105 patients were included, where 53% had highly experienced assistants and 47% had less experienced ones. Low assistant experience and higher BMI predicted longer operative time (OT), confirmed by multivariable regression (β = 40.5, confidence interval [CI] 18.7–62.3, p < 0.001). Assistant experience did not significantly affect EBL or LOS after adjusting for covariates (β = −14.2, CI −91.8–63.3, p = 0.7 and β = −0.83, CI −2.7–1.02, p = 0.4, respectively). There was no correlation between assistant experience and postoperative complications. Conclusions: Assistant experience does not significantly impact complications, EBL, and LOS in laparoscopic nephrectomy. Surgeries with less experienced assistants had longer OT, but the overall clinical impact seems limited. Trainee involvement remains safe, guided by experienced surgeons.

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Identifying Preoperative Predictors of Operative Time and Their Impact on Outcomes in Robot-Assisted Partial Nephrectomy

Cited by 7 publications

References 33 publications

Single-port vs multi-port robot-assisted renal surgery: analysis of perioperative outcomes for excision of high and low complexity renal masses

Single-port vs multi-port robot-assisted renal surgery: analysis of perioperative outcomes for excision of high and low complexity renal masses

Single-port Vs Multi-port Robot-assisted Renal Surgery: Analysis of Perioperative Outcomes for Excision of High and Low Complexity Renal Masses

Impact of Assistant Experience on Perioperative Outcomes of Simple and Radical Laparoscopic Nephrectomy: Does It Really Matter?

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