Prata Francesco, Basile Salvatore, Tedesco Francesco, Ragusa Alberto, Pira Matteo, Iannuzzi Andrea, Fantozzi Marco, Civitella Angelo, Scarpa Roberto Mario, Papalia Rocco
Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy.
J Clin Med. 2024 Apr 11;13(8):2226. doi: 10.3390/jcm13082226.
: The absence of validated tools to assess the skill transfer from laparoscopy to robotic surgery remains an unsolved issue in the context of robot-assisted partial nephrectomy (RAPN). We aimed to describe and validate a novel proficiency score to critically evaluate the surgical quality of RAPN with the Hugo™ RAS System (Medtronic, Minneapolis, MN, USA). : Between October 2022 and September 2023, 27 consecutive patients underwent off-clamp RAPN for localized renal tumors at our institution. To analyze the learning curve (LC), the cohort was chronologically divided into two phases of 6 months each. Proficiency was defined as the achievement of trifecta while maintaining a comparable intraoperative time in the interquartile range of laparoscopic partial nephrectomy performed by the same surgeon. A logistic binary regression model was built to identify predictors of proficiency achievement. : A proficiency score was achieved in 14 patients (74.1%). At univariable analysis, number of consecutive procedures > 12 (OR 13.7; 95%CI 2.05-21.1, = 0.007), pathological tumor size (OR 0.92; 95%CI 0.89-0.99, = 0.04) and essential blood hypertension (OR 0.16; 95%CI 0.03-0.82, = 0.02) were found to be predictors of proficiency score. At multivariable analysis, after adjusting for potential confounding factors, number of consecutive procedures > 12 (OR 8.1; 95%CI 1.44-14.6, = 0.03) was the only independent predictor of proficiency score achievement. : Our results showed that the skills of an experienced laparoscopic surgeon are transferrable to the novel Hugo™ RAS System in the context of nephron-sparing surgery. Improved surgical quality may be expected after completing the first 12 consecutive procedures.
在机器人辅助部分肾切除术（RAPN）的背景下，缺乏经过验证的工具来评估从腹腔镜手术到机器人手术的技能转移仍然是一个未解决的问题。我们旨在描述和验证一种新的熟练度评分，以严格评估使用Hugo™机器人辅助手术系统（美敦力公司，明尼阿波利斯，明尼苏达州，美国）进行的RAPN的手术质量。2022年10月至2023年9月期间，我们机构连续27例患者因局限性肾肿瘤接受了非阻断性RAPN。为了分析学习曲线（LC），该队列按时间顺序分为两个各为期6个月的阶段。熟练度定义为在同一位外科医生进行的腹腔镜部分肾切除术的四分位间距内保持可比的术中时间的同时实现三连胜。建立了一个逻辑二元回归模型来识别熟练度达成的预测因素。14例患者（74.1%）达到了熟练度评分。在单变量分析中，连续手术次数>12次（OR 13.7；95%CI 2.05 - 21.1，P = 0.007）、病理肿瘤大小（OR 0.92；95%CI 0.89 - 0.99，P = 0.04）和原发性高血压（OR 0.16；95%CI 0.03 - 0.82，P = 0.02）被发现是熟练度评分的预测因素。在多变量分析中，在调整潜在混杂因素后，连续手术次数>12次（OR 8.1；95%CI 1.44 - 14.6，P = 0.03）是熟练度评分达成的唯一独立预测因素。我们的结果表明，在保留肾单位手术的背景下，经验丰富的腹腔镜外科医生的技能可转移到新型Hugo™机器人辅助手术系统。在完成连续12次手术后，手术质量可能会得到改善。
