The role of the assistant during robot-assisted partial nephrectomy: does experience matter?

Area of Science:

• Urology
• Surgical Oncology
• Robotic Surgery

Background:

• Robot-assisted partial nephrectomy (RPN) is a complex procedure.
• The role of bedside assistant experience in surgical outcomes is often debated.

Purpose of the Study:

• To evaluate the impact of bedside assistant experience level on surgical outcomes during RPN.
• To determine if junior vs. senior assistants affect key performance metrics in RPN.

Main Methods:

• Retrospective review of 414 RPN cases performed by experienced robotic surgeons.
• Classification of assistants into junior (PGY-2/3, nurse first assistant) and senior (PGY-4/5, fellow) levels.
• Multivariate analyses using linear, Poisson, and logistic regression models.

Main Results:

• No significant difference in operative time (p=0.656), warm ischemia time (p=0.843), or negative margin rates (p=0.340) between junior and senior assistant groups.
• Postoperative complication rates were similar (14.8% junior vs. 11.7% senior, p=0.408).
• Multivariate analysis confirmed assistant experience did not significantly impact operative time, blood loss, or complications.

Conclusions:

• The postgraduate year (PGY) status of a physician trainee acting as a bedside assistant does not appear to influence RPN outcomes.
• High-volume centers and experienced lead surgeons may mitigate variations in assistant experience.
• These findings may alleviate concerns regarding the impact of trainee experience on RPN success.