Impact of Surgical Experience Before Robot-assisted Partial Nephrectomy on Surgical Outcomes: A Multicenter Analysis of 2500 Patients

Harke, Nina; Kuczyk, Markus A.; Huusmann, Stephan; Schiefelbein, Frank; Schneller, Andreas; Schoen, Georg; Wiesinger, Clemens Georg; Pfuner, Jacob; Ubrig, Burkhard; Gloger, Simon; Eraky, Ahmed; Witt, J.H.; Liakos, Nikolaos; Wagner, Christian von; Hadaschik, Boris; Radtke, Jan-Philipp; Nader, Michael; Imkamp, Florian; Siemer, Stefan; Stöckle, Michael; Zeuschner, Philip

doi:10.1016/j.euros.2022.10.003

Cited by 10 publications

(5 citation statements)

References 28 publications

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“…However, body mass index, patient age, and kidney complexity also had significant associations with the aforementioned outcomes. 20 Enucleoresection was associated with a significantly higher risk of PSM compared with resection (odds ratio [OR], 5.73; P = .02) and enucleation (OR, 2.42; P = .03). 21 Laparoscopic partial nephrectomy was associated with a significantly higher risk of PSM compared with the open approach (OR, 1.36; P = .02).…”

Section: Discussionmentioning

confidence: 99%

“…Greater surgeon experience was associated with lower operative time, WIT, and major postoperative complications for robot-assisted partial nephrectomy. However, body mass index, patient age, and kidney complexity also had significant associations with the aforementioned outcomes . Enucleoresection was associated with a significantly higher risk of PSM compared with resection (odds ratio [OR], 5.73; P = .02) and enucleation (OR, 2.42; P = .03) .…”

Section: Discussionmentioning

confidence: 99%

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Surgeon Skill and Perioperative Outcomes in Robot-Assisted Partial Nephrectomy

Wang,

Wilder,

Hijazi

et al. 2024

JAMA Netw Open

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ImportanceTechnical skill in complex surgical procedures may affect clinical outcomes, and there is growing interest in understanding the clinical implications of surgeon proficiency levels.ObjectivesTo determine whether surgeon scores representing technical skills of robot-assisted kidney surgery are associated with patient outcomes.Design, Setting, and ParticipantsThis quality improvement study included 10 urological surgeons participating in a surgical collaborative in Michigan from July 2021 to September 2022. Each surgeon submitted up to 7 videos of themselves performing robot-assisted partial nephrectomy. Videos were segmented into 6 key steps, yielding 127 video clips for analysis. Each video clip was deidentified and distributed to at least 3 of the 24 blinded peer surgeons from the collaborative who also perform robot-assisted partial nephrectomy. Reviewers rated technical skill and provided written feedback. Statistical analysis was performed from May 2023 to January 2024.Main Outcomes and MeasuresReviewers scored each video clip using a validated instrument to assess technical skill for partial nephrectomy on a scale of 1 to 5 (higher scores indicating greater skill). For all submitting surgeons, outcomes from a clinical registry were assessed for length of stay (LOS) greater than 3 days, estimated blood loss (EBL) greater than 500 mL, warm ischemia time (WIT) greater than 30 minutes, positive surgical margin (PSM), 30-day emergency department (ED) visits, and 30-day readmission.ResultsAmong the 27 unique surgeons who participated in this study as reviewers and/or individuals performing the procedures, 3 (11%) were female, and the median age was 47 (IQR, 39-52) years. Risk-adjusted outcomes were associated with scores representing surgeon skills. The overall performance score ranged from 3.5 to 4.7 points with a mean (SD) of 4.1 (0.4) points. Greater skill was correlated with significantly lower rates of LOS greater than 3 days (−6.8% [95% CI, −8.3% to −5.2%]), EBL greater than 500 mL (−2.6% [95% CI, −3.0% to −2.1%]), PSM (−8.2% [95% CI, −9.2% to −7.2%]), ED visits (−3.9% [95% CI, −5.0% to −2.8%]), and readmissions (−5.7% [95% CI, −6.9% to −4.6%]) (P &lt; .001 for all). Higher overall score was also associated with higher partial nephrectomy volume (β coefficient, 11.4 [95% CI, 10.0-12.7]; P &lt; .001).Conclusions and RelevanceIn this quality improvement study on video-based evaluation of robot-assisted partial nephrectomy, higher technical skill was associated with lower rates of adverse clinical outcomes. These findings suggest that video-based evaluation plays a role in assessing surgical skill and can be used in quality improvement initiatives to improve patient care.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Surgeon Skill and Perioperative Outcomes in Robot-Assisted Partial Nephrectomy

Wang,

Wilder,

Hijazi

et al. 2024

JAMA Netw Open

View full text Add to dashboard Cite

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“…Second, the studies included in the review exhibit great heterogeneity, and most were single-center experiences in referral institutions. Mastery of RPN is an ongoing learning process for which prior experience does count [50] . Expert surgeons are more likely to perform enucleation than beginners, and we were unable to exclude the possibility that the potential advantages found for enucleation could be related to surgeon expertise rather than the resection technique.…”

Section: Discussionmentioning

confidence: 99%

Resection Techniques During Robotic Partial Nephrectomy: A Systematic Review

Bertolo¹,

Pecoraro²,

Carbonara³

et al. 2023

European Urology Open Science

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“…We can conclude that the robotic-assisted procedure was an independent protective factor and offered a lower rate of complications. However, since S-RALPN has a learning curve requiring 30-40 cases to master (19) and selectively identify and isolate the renal hilum, especially for surgeons at the beginning of their career in robotic surgery, RAPN may lead to suboptimal outcomes. STE via DSA perfectly solves the problem.…”

Section: Discussionmentioning

confidence: 99%

Clinical application of superselective transarterial embolization of renal tumors in zero ischaemia robotic-assisted laparoscopic partial nephrectomy

Li,

Hu,

et al. 2023

Front. Oncol.

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ObjectiveTo assess the feasibility and safety of zero ischaemia robotic-assisted laparoscopic partial nephrectomy (RALPN) after preoperative superselective transarterial embolization (STE) of T1 renal cancer.MethodsWe retrospectively analyzed the data of 32 patients who underwent zero ischaemia RALPN after STE and 140 patients who received standard robot-assisted laparoscopic partial nephrectomy (S-RALPN). In addition, we selected 35 patients treated with off-clamp RALPN (O-RALPN) from September 2017 to March 2022 for comparison. STE was performed by the same interventional practitioner, and zero ischaemia laparoscopic partial nephrectomy (LPN) was carried out by experienced surgeon 1-12 hours after STE. The intraoperative data and postoperative complications were recorded. The postoperative renal function, routine urine test, urinary Computed Tomography (CT), and preoperative and postoperative glomerular filtration rate (GFR) data were analyzed.ResultsAll operations were completed successfully. There were no cases of conversion to opening and no deaths. The renal arterial trunk was not blocked. No blood transfusions were needed. The mean operation time was 91.5 ± 34.28 minutes. The mean blood loss was 58.59 ± 54.11 ml. No recurrence or metastasis occurred.ConclusionFor patients with renal tumors, STE of renal tumors in zero ischaemia RALPN can preserve more renal function, and it provides a safe and feasible surgical method.

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Impact of Surgical Experience Before Robot-assisted Partial Nephrectomy on Surgical Outcomes: A Multicenter Analysis of 2500 Patients

Cited by 10 publications

References 28 publications

Surgeon Skill and Perioperative Outcomes in Robot-Assisted Partial Nephrectomy

Surgeon Skill and Perioperative Outcomes in Robot-Assisted Partial Nephrectomy

Resection Techniques During Robotic Partial Nephrectomy: A Systematic Review

Clinical application of superselective transarterial embolization of renal tumors in zero ischaemia robotic-assisted laparoscopic partial nephrectomy

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