Total robotic surgical volume influences outcomes of low-volume robotic-assisted partial nephrectomy over an extended duration.

INTRODUCTION

The objective of this study was to examine the surgeon's experience of low-volume robotic-assisted partial nephrectomy (RAPN) over an extended duration, and whether a high-volume fellowship training influenced the outcomes.

METHODS

Data on all RAPN at a tertiary center performed by a uro-oncologist were retrospectively collected. The surgeon experience was assessed by examining perioperative outcomes among three groups of consecutive patients (first=14, second=14, third=15 patients, respectively).

RESULTS

Between February 2014 and February 2020, 45 RAPNs were performed out of a total of 200 robotic procedures. The median tumor size was 3 cm, and 28 (65%) patients had a R.E.N.A.L nephrometry score (RNS) ≥7. The median operative time and warm ischemia time (WIT) were 190 and 16 minutes, respectively. The median estimated blood loss (EBL) was 100 mL. Two (4%) patients had a positive surgical margin (PSM). Overall, five (12%) complications were recorded. All except one were minor (Clavien I-II). The median followup was 26.2 months. Trifecta and pentafecta were achieved in 40 (93%) and 27 (81.8%) patients, respectively. Increased surgeon experience was significantly associated with a shorter operative time and less EBL. Furthermore, there was an independent association between surgeon experience and operative time and EBL, and between RNS and operative time and WIT.

CONCLUSIONS

With fellowship training and subsequent adequate total number of robotic procedures during practice, it is possible to perform RAPN with favorable perioperative outcomes in the setting of low-volume of cases over an extended duration.