The learning curve for robot-assisted partial nephrectomy: Impact of surgical experience on perioperative outcomes

Larcher, Alessandro; Muttin, Fabio; Peyronnet, B.; Naeyer, Geert De; Cianflone, Francesco; Ripa, Francesco; Capitanio, Umberto; Salonia, A.; Briganti, A.; Montorsi, F.; Bensalah, K.; Mottrie, Alexandre

doi:10.1016/s1569-9056(18)33205-6

Cited by 11 publications

(12 citation statements)

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“…Our results have implications for empirical research. Evidence that outcomes of surgery are influenced by surgical experience [28,29] suggests that the inclusion of such a feature might improve risk stratification. It would not be surprising that the probability of functional damage might be lowered using the surgical approach a surgeon is more confident with [30].…”

Section: Discussionmentioning

confidence: 99%

Toward Individualized Approaches to Partial Nephrectomy: Assessing the Correlation Between Ischemia Time and Patient Health Status (RECORD2 Project)

Bravi

Mari

Larcher

et al. 2021

European Urology Oncology

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Background: Ischemia time during partial nephrectomy (PN) is among the greatest determinants of acute kidney injury (AKI). Whether this association is affected by the preoperative risk of AKI has never been investigated. Objective: To assess the effect of the interaction between the preoperative risk of AKI and ischemia time on the probability of AKI during PN. Design, setting, and participants: Data of 944 patients treated with on-clamp PN for cT1 renal tumors were extracted from the Registry of Conservative and Radical Surgery for Cortical Renal Tumor Disease (RECORD2) database, a prospective multicenter project. Outcome measurements and statistical analysis: We estimated the preoperative risk of AKI (defined according to the risk/injury/failure/loss/end-stage [RIFLE]

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Section: Discussionmentioning

confidence: 99%

Toward Individualized Approaches to Partial Nephrectomy: Assessing the Correlation Between Ischemia Time and Patient Health Status (RECORD2 Project)

Bravi

Mari

Larcher

et al. 2021

European Urology Oncology

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“…We suspected that an inherent learning curve in the RAPN cohort might affect the surgical results. Learning curves of robotic surgeons have shown to be steeper than in laparoscopy and do not level out until 300 RAPN cases 35,36 . For this reason, we conducted a time‐dependent subgroup analysis by comparing cases from 2007 to 2012 with 2013 to 2018 only within RAPN and OPN groups (see Table ).…”

Section: Discussionmentioning

confidence: 99%

“…It was not surprising that RAPN did not reach lower postoperative complication rates than OPN from 2007 to 2012. Larcher et al recently illustrated a learning curve for a complication‐free course as a function of the robotic surgeon's experience 36 . They showed that increasing experience lowered the risk of complications in RAPN.…”

Section: Discussionmentioning

confidence: 99%

Open versus robot‐assisted partial nephrectomy: A longitudinal comparison of 880 patients over 10 years

Zeuschner

Greguletz

Meyer

et al. 2020

Robotics Computer Surgery

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Background Most comparisons between robot‐assisted partial nephrectomy (RAPN) and open partial nephrectomy (OPN) indicate the superiority of RAPN, but the learning curve is often not considered. Methods All consecutive partial nephrectomies from the very first RAPN at a single tertiary referral centre (n = 818, 500 RAPN vs. 313 OPN) were retrospectively analyzed. Complications, success rates and surgical outcomes were compared. Inequalities between cohorts and the inherent learning curve were controlled by subgroup comparisons, regression analyses, and propensity score matching. Results Overall, RAPN had fewer complications, less blood loss, and shorter length of stay. However, an inherent learning curve caused higher complications for the first 4 years. Thereafter, perioperative outcomes clearly favoured RAPN, even for more complex tumours. Conclusions In one of the largest monocentric cohorts over more than 10 years, RAPN was found to be superior to OPN. However, not all advantages of RAPN are immediate because a learning curve must be passed.

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“…Surgical experience was also coded as the number of prior RsRARP procedures performed by each surgeon at the time of the index patient’s operation. Locally weighted scatter‐plot smoothing (LOWESS) [17] was used to explore graphically the relationship between surgical experience and operating time, immediate urinary continence recovery, PSM status, Clavien–Dindo grade ≥2 90‐day postoperative complications, after adjustment for case mix (age, any previous surgery, body mass index, previous active surveillance, risk groups and prostate volume) and for clustering at single surgeon level, using generalized estimation equations [18].…”

Section: Methodsmentioning

confidence: 99%

Retzius‐sparing robot‐assisted radical prostatectomy: early learning curve experience in three continents

et al. 2020

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Objective To assess the effect of surgical experience on peri‐operative, functional and oncological outcomes during the first 50 Retzius‐sparing robot‐assisted radical prostatectomy (RsRARP) cases performed by surgeons naïve to this novel approach. Materials and Methods We retrospectively evaluated the initial cases operated by 14 surgeons in 12 different international centres. Pre‐, peri‐ and postoperative features of the first 50 patients operated by each surgeon in all the participating centres were collected. The effect of surgical experience on peri‐operative, functional and oncological outcomes was firstly evaluated after stratification by level of surgical experience (initial [≤25 cases] and expert [>25 cases]) and after using locally weighted scatterplot smoothing to graphically explore the relationship between surgical experience and the outcomes of interest. Results We evaluated 626 patients. The median follow‐up was 13 months in the initial group and 9 months in the expert group (P = 0.002). Preoperative features overlapped between the two groups. Shorter console time (140 vs 120 min; P = 0.001) and a trend towards lower complications rates (13 vs 5.5%; P = 0.038) were observed in the expert group. The relationship between surgical experience and console time, immediate urinary continence recovery and Clavien–Dindo grade ≥2 complications was linear, without reaching a plateau, after 50 cases. Conversely, a non‐linear relationship was observed between surgical experience and positive surgical margins (PSMs). Conclusions In this first report of a multicentre experience of RsRARP during the learning curve, we found that console time, immediate urinary continence recovery and postoperative complications are optimal from the beginning and further quickly improve during the learning process, while PSM rates did not clearly improve over the first 50 cases.

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The learning curve for robot-assisted partial nephrectomy: Impact of surgical experience on perioperative outcomes

Cited by 11 publications

References 0 publications

Toward Individualized Approaches to Partial Nephrectomy: Assessing the Correlation Between Ischemia Time and Patient Health Status (RECORD2 Project)

Toward Individualized Approaches to Partial Nephrectomy: Assessing the Correlation Between Ischemia Time and Patient Health Status (RECORD2 Project)

Open versus robot‐assisted partial nephrectomy: A longitudinal comparison of 880 patients over 10 years

Retzius‐sparing robot‐assisted radical prostatectomy: early learning curve experience in three continents

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