Pecoraro Alessio, Andras Iulia, Boissier Romain, Hevia Vital, Prudhomme Thomas, Serni Sergio, Breda Alberto, Campi Riccardo, Territo Angelo
Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy.
Department of Urology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
Minerva Urol Nephrol. 2022 Dec;74(6):669-679. doi: 10.23736/S2724-6051.22.04909-6. Epub 2022 May 27.
There is lack of evidence on the impact of surgeons' learning curve on postoperative outcomes after open (OKT) or minimally-invasive (robot-assisted) kidney transplantation (RAKT). The aim of the review was to assess the learning curve (LC) for OKT and RAKT, focusing on intra-, perioperative and functional outcomes.
A systematic review of the English-language literature published between 01/01/2000 - 10/12/2021 was conducted using the MEDLINE (Via PubMed), Web of Science and the Cochrane Library databases according to the principles highlighted by the EAU Guidelines Office and the PRISMA statement recommendations. The review protocol was registered on PROSPERO (CRD42022301132). The overall quality of evidence was assessed according to GRADE recommendations.
Twelve studies were included in the qualitative analysis. Surgical competence in terms of operative and re-warming times was defined after 30 cases in OKT and after 11-35 cases in RAKT. Decreased complications rates were observed after 20-33 cases in OKT and 10-30 cases in RAKT. Optimal functional outcomes were achieved after 33 cases in OKT and 15-25 cases in RAKT. However, while a poor OKT experience did not influence the LC for RAKT, lack of robotic surgery exposure could lead to a longer LC for the robotic approach.
OKT and RAKT appear to have similar LCs and might require about 30 cases to achieve optimal surgical and functional outcomes. Previous expertise in OKT is warranted to shorten the LC for RAKT. Further research is needed to validate these thresholds using standardized reporting metrics.
关于外科医生的学习曲线对开放性（OKT）或微创性（机器人辅助）肾移植（RAKT）术后结局的影响，目前缺乏证据。本综述的目的是评估OKT和RAKT的学习曲线（LC），重点关注术中、围手术期和功能结局。
根据欧洲泌尿外科学会指南办公室强调的原则和PRISMA声明建议，使用MEDLINE（通过PubMed）、科学网和Cochrane图书馆数据库，对2000年1月1日至2021年12月10日发表的英文文献进行系统综述。该综述方案已在PROSPERO（CRD42022301132）上注册。根据GRADE建议评估证据的总体质量。
定性分析纳入了12项研究。OKT中30例手术后、RAKT中11 - 35例手术后，在手术操作和复温时间方面确定了手术能力。OKT中20 - 33例、RAKT中10 - 30例手术后观察到并发症发生率降低。OKT中33例、RAKT中15 - 25例手术后实现了最佳功能结局。然而，虽然OKT经验不足不会影响RAKT的学习曲线，但缺乏机器人手术经验可能会导致机器人手术方法的学习曲线更长。
OKT和RAKT似乎具有相似的学习曲线，可能需要约30例手术才能实现最佳手术和功能结局。需要有OKT的既往专业经验来缩短RAKT的学习曲线。需要进一步研究使用标准化报告指标来验证这些阈值。
