Does experience in creating a robot-assisted partial nephrectomy (RAPN) programme in an academic centre impact outcomes or complication rate?

Authors


Correspondence: Ashok K. Hemal, Department of Urology, Wake Forest University School of Medicine, Wake Forest University Health Sciences, Medical Center Boulevard, Winston-Salem, NC 27157-1094, USA.

e-mail: ahemal@wakehealth.edu

Abstract

Objective

  • To evaluate the impact of increased experience in robot-assisted partial nephrectomy (RAPN) on perioperative and oncological outcomes
  • To detail the complications encountered in establishing a RAPN programme at a tertiary referral centre and the factors associated with these complications

Patients and Methods

  • The initial consecutive 233 patients undergoing RAPN between March 2008 and May 2012 at our institution were identified.
  • Patients were divided into quartiles to evaluate outcomes, and uni- and multivariate predictors of complications were calculated

Results

  • In progressive quartiles, patients tended to have more complex renal tumours as evaluated by R.E.N.A.L. nephrometry (P < 0.01) or preoperative aspects and dimensions used for an anatomical classification (PADUA) scores (P = 0.003), and percentage endophytic (P = 0.01).
  • Developing technique increased the patients undergoing unclamped PN (P < 0.01).
  • The mean time in the operating room (from skin incision to closure) decreased significantly from 225 to 183 min (P < 0.01) and warm ischaemia time decreased from 28 to 15 min, when clamping (P < 0.01).
  • Clavien graded complication rate (P = 0.26) and positive margin rate (P = 0.32) was unchanged by quartile.

Conclusion

  • We show that increasing experience allows more complex tumours to be removed with similar outcomes in patients undergoing RAPN.
  • The complication rates and perioperative outcomes were similar in four successive quartiles of an initial experience of RAPN.

Ancillary