Learning Curves for Robot-Assisted and Laparoscopic Partial Nephrectomy

Hanzly, Michael; Frederick, Ariel; Creighton, Terrance; Atwood, Kris; Mehedint, Diana; Kauffman, Eric; Kim, Hyung L.; Schwaab, Thomas

doi:10.1089/end.2014.0303

Cited by 77 publications

(46 citation statements)

References 19 publications

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“…One potential limitation of MIPN is the surgical learning curve, which appears to be longer with LPN than with RPN. [15][16][17][18] Most studies suggest that outcomes improve after a surgeon completes between 30 and 40 cases. The current work supports the notion that complication rates are higher during a surgeon's (or institution's) learning curve: major and hemorrhagic complications were nearly twofold higher for ''PN performed during the first year after acquisition of the robot'' (p = 0.02).…”

mentioning

confidence: 99%

Comparison of 1800 Robotic and Open Partial Nephrectomies for Renal Tumors

Bezinque

Lane

2016

Ann Surg Oncol

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Partial nephrectomy (PN) is the reference standard for renal tumors that are amenable to a kidney-sparing approach. With oncologic outcomes superior to thermal ablation and renal functional outcomes superior to radical nephrectomy, the number of situations in which PN is employed is growing.1,2 The outcomes of PN vary greatly with surgeon experience, variations in technique, and tumor complexity. Several techniques have been developed and modified during the past 30 years or more, with contemporary discussions addressing optimization of the oncologic, renal functional, and postoperative outcomes of PN. 3During the late 1990s, minimally invasive PN was pioneered using pure laparoscopic techniques. 4,5 In the initial single-center series reported, laparoscopic PN (LPN) was found to be feasible and with acceptable morbidity when performed by master laparoscopic surgeons who were building upon the experience of prior experts' open surgical techniques. [4][5][6] Comparison of results from these initial series of LPN with OPN performed well after the initial learning curve for this procedure revealed both advantages and disadvantages for LPN despite the somewhat imbalanced comparison.7 LPN offered the advantages of decreased operative time (median 3. In these 1800 patients, the disadvantages of LPN were longer warm ischemia time (median 31 vs. 20 min; RR: 1.69 (95 % CI: 1.62-1.77), p \ 0.0001), more urologic complications (9.2 vs. 5.0 %; odds ratio [OR]: 2.14 (95 % CI: 1.39-3.31), p = 0.0006), and more nonurologic complications (15.7 vs. 14.3 %; OR: 1.53 (95 % CI: 1.12-2.10), p = 0.0077). The major concerns for LPN were the higher observed rate of postoperative hemorrhage and urine leak that was accentuated by the larger tumors and less fit patients in the cohort undergoing OPN. 6 With further refinements in technique, the results of minimally invasive PN have improved substantially during 15? years of refinement. 3,8 With LPN, and more recently with robotic PN (RPN), ischemia times and complications have decreased substantially.3,9 When directly comparing similar cohorts undergoing LPN or RPN by the same surgeons, RPN was associated with shorter hospital stays (2.4 vs. 2.7 days), shorter ischemic intervals (19.7 vs. 28.4 min), and lower complication rates (8.6 vs. 10.2 %) in a multi-institutional study.10 Meta-analysis of multiple retrospective studies indicated that LPN and RPN provided comparable hospital stay and complication rates, with an advantage of shorter ischemia time for RPN even with greater tumor complexity in these cases.9 RPN appears to have extended the reach of LPN, enabling PN to be performed in more complex scenarios and by a greater number of proficient surgeons.The published evidence has suggested that RPN can likely be performed with a favorable risk-benefit profile relative to OPN for well-selected patients. 3,[11][12][13] This present report confirms these prior reports.14 Peyronnet et al. report in this issue of Annals of Surgical Oncology that RPN is associated with favorable perioperat...

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confidence: 99%

Comparison of 1800 Robotic and Open Partial Nephrectomies for Renal Tumors

Bezinque

Lane

2016

Ann Surg Oncol

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“…In the past few years, urologists have preferred to perform a PN to treat a localized renal tumour, and their primary priorities are to assure complete tumour removal, retain the remaining renal function, and apply a minimally invasive technique when available. 15,16 Since the tumour enucleation technique was introducted, [17][18][19] this approach, combined with robotic surgery, has revolutionized the PN technique, and its use has progressively increased in recent years due to its various advantages compared with laparoscopic or open surgery. 20,21 Thus, standardizing the reporting of the ERASE results is necessary to evaluate and compare the efficacy of the different procedures.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic robot‐assisted simple enucleation of renal tumours: Impact of learning curve and tumour complexity on trifecta outcomes

Zhou

Yang

et al. 2019

Robotics Computer Surgery

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Background In this article, we report the outcomes of endoscopic robot‐assisted tumour enucleation (ERASE) using a trifecta system. Methods One hundred eighty‐two patients were treated with ERASE by a single surgeon between October 2014 and February 2017 and were stratified by quartiles of distribution called ERASE eras 1 to 4 and preoperative aspects and dimensions used for an anatomical (PADUA) score risk group categories. The trifecta achievement rates in different ERASE eras and PADUA score risk group categories were analysed. Results The overall trifecta achievement rate was 76.4%; this rate progressively increased along the learning curve and reached 87.2% in ERASE era 4 (0.002). PADUA score risk group categories were inversely correlated with the trifecta achievement rate (P < .001). When both variables were simultaneously considered, a trend towards a higher trifecta achievement rate was observed in the recent series regardless of tumour anatomical complexity. Conclusions The trifecta achievement rate increased with surgical experience and was inversely correlated with tumour complexity.

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“…Partial nephrectomy has increasingly become the standard of care for certain renal lesions . With the advent of laparoscopy and robot assistance, intracorporeal suturing and renal reconstruction remain the main technical challenges of minimally invasive surgery . After dissection of the renal tumor, adequate re‐approximation of remnant renal tissues is crucial for hemostasis.…”

Section: Summary Of Maximum Tension Before Slippagementioning

confidence: 99%