Achieving trifecta outcomes in robotic-assisted partial nephrectomy within a fellowship training centre

Area of Science:

• Urology
• Surgical Oncology
• Medical Education

Background:

• Robotic-assisted partial nephrectomy (RAPN) is increasingly utilized for kidney tumor management.
• Assessing surgical outcomes within fellowship training programs is crucial for quality assurance.
• The 'trifecta' outcome (negative margins, no complications, short warm ischemia time) is a key metric for successful partial nephrectomy.

Purpose of the Study:

• To evaluate the trifecta rate of robotic-assisted partial nephrectomy (RAPN) performed within a surgical fellowship program.
• To identify factors associated with achieving the trifecta outcome in a training setting.

Main Methods:

• A prospectively maintained database was used to identify patients who underwent RAPN between 01/01/2010 and 01/07/2023.
• Patients converted to open or radical nephrectomy were excluded.
• The primary outcome was the achievement of the trifecta: negative surgical margins, no complications within 30 days, and warm ischemia time (WIT) < 25 minutes.

Main Results:

• Out of 348 eligible patients, 253 (75%) achieved the trifecta outcome.
• High rates were observed for individual trifecta components: WIT < 25 min (96%), negative margins (93%), and complication-free at 30 days (84%).
• No significant differences in patient or tumor factors were found between patients who achieved the trifecta and those who did not.

Conclusions:

• The trifecta outcome in robotic-assisted partial nephrectomy is achievable in a fellowship training program at a rate comparable to international standards.
• Fellowship programs can successfully train surgeons while maintaining high patient outcomes.
• Continuous monitoring of outcomes is recommended for training centers to ensure quality care alongside educational requirements.