Does experience in creating a robot-assisted partial nephrectomy (RAPN) programme in an academic centre impact...

Area of Science:

• Urology
• Minimally Invasive Surgery
• Oncology

Background:

• Robot-assisted partial nephrectomy (RAPN) is a complex procedure requiring significant surgical experience.
• Establishing a new RAPN program involves challenges and potential complications.
• Evaluating the impact of experience on outcomes is crucial for program development.

Purpose of the Study:

• To assess how increasing surgeon experience in RAPN affects perioperative and oncological results.
• To identify complications during the initial phase of a RAPN program and associated risk factors.

Main Methods:

• Analysis of 233 consecutive RAPN cases from March 2008 to May 2012.
• Patients were grouped into quartiles to evaluate outcomes based on experience.
• Univariate and multivariate analyses were performed to identify predictors of complications.

Main Results:

• Progressive quartiles showed a trend towards treating more complex renal tumors (higher R.E.N.A.L. and PADUA scores, increased endophytic tumors).
• The rate of unclamped partial nephrectomy (PN) increased with experience.
• Operating room time decreased significantly (225 to 183 min), as did warm ischemia time (28 to 15 min).
• Complication rates (Clavien grade) and positive margin rates remained consistent across quartiles.

Conclusions:

• Increased experience in RAPN enables the safe resection of more complex kidney tumors.
• Perioperative and oncological outcomes, as well as complication rates, were comparable across successive quartiles of initial RAPN experience.