Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; ORSI Academy, Melle, Belgium; Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium.
Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
Eur Urol. 2019 Feb;75(2):253-256. doi: 10.1016/j.eururo.2018.08.042. Epub 2018 Sep 19.
Robot-assisted partial nephrectomy (RAPN) outcomes might be importantly affected by increasing surgical experience (EXP). The aim of the study is to investigate the effect of EXP on warm ischemia time (WIT), presence of at least one Clavien-Dindo ≥2 postoperative complication (CD ≥ 2), and positive surgical margins (PSMs) to define the learning curve for RAPN. We evaluated 457 consecutive patients diagnosed with a cT1-T2 renal mass were evaluated. EXP was defined as the total number of RAPNs performed by each surgeon before each patient's operation. Median WIT was 14min and the rate of CD ≥ 2 and PSMs was 15% and 4%, respectively. At multivariable regression analyses adjusted for case mix, EXP resulted associated with shorter WIT (p<0.0001) and higher probability of CD ≥ 2-free postoperative course (p=0.001), but not with PSMs (p=0.7). The relationship between EXP and WIT emerged as nonlinear, with a steep slope reduction within the first 100 cases and a plateau observed after 150 cases. Conversely, the relationship between EXP and CD ≥ 2-free course resulted linear, without reaching a plateau, even after 300 cases. Patient summary: Perioperative outcomes after robot-assisted partial nephrectomy (RAPN) are importantly and individually affected by surgeon's experience. After 150 RAPNs, no further improvement is observed with respect to ischemia time, but the learning curve appears endless with respect to complications.
机器人辅助部分肾切除术 (RAPN) 的结果可能会受到手术经验 (EXP) 的重要影响。本研究旨在探讨 EXP 对热缺血时间 (WIT)、至少有一个 Clavien-Dindo ≥ 2 术后并发症 (CD ≥ 2) 和阳性手术切缘 (PSMs) 的影响，以确定 RAPN 的学习曲线。我们评估了 457 例连续诊断为 cT1-T2 肾肿瘤的患者。EXP 定义为每位外科医生在每位患者手术前进行的 RAPN 总数。中位 WIT 为 14 分钟，CD ≥ 2 和 PSMs 的发生率分别为 15%和 4%。在多变量回归分析中，根据病例组合调整后，EXP 与 WIT 缩短相关（p<0.0001）和更高的 CD ≥ 2 无术后并发症的可能性相关（p=0.001），但与 PSMs 无关（p=0.7）。EXP 和 WIT 之间的关系是非线性的，在前 100 例中斜率急剧下降，在 150 例后出现平台。相反，EXP 和 CD ≥ 2 无术后并发症之间的关系是线性的，即使在 300 例后也没有达到平台。患者总结：机器人辅助部分肾切除术 (RAPN) 后的围手术期结果受到外科医生经验的重要影响。进行 150 例 RAPN 后，缺血时间不会进一步改善，但并发症的学习曲线似乎没有尽头。
