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The learning curve and factors affecting warm ischemia time during robot-assisted partial nephrectomy.

Dube H, Bahler CD, Sundaram CP - Indian J Urol (2015 Jul-Sep)

Bottom Line: The learning curve was defined as the number of procedures needed to reach the targeted goal for WIT, which most recently was 20 min.Body mass index (P = 0.87), age (P = 0.38), complication rate (P = 0.16), operating time (P = 0.78) and estimated blood loss (P = 0.98) did not change.A multivariable analysis found nephrometry score, tumor diameter, cortical renorrhaphy and year of surgery to be significant predictors of WIT.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.

ABSTRACT

Introduction: The learning curve for robotic partial nephrectomy was investigated for an experienced laparoscopic surgeon and factors associated with warm ischemia time (WIT) were assessed.

Materials and methods: Between 2007 and 2014, one surgeon completed 171 procedures. Operative time, blood loss, complications and ischemia time were examined to determine the learning curve. The learning curve was defined as the number of procedures needed to reach the targeted goal for WIT, which most recently was 20 min. Statistical analyses including multivariable regression analysis and matching were performed.

Results: Comparing the first 30 to the last 30 patients, mean ischemia time (23.0-15.2 min, P < 0.01) decreased while tumor size (2.4-3.4 cm, P = 0.02) and nephrometry score (5.9-7.0, P = 0.02) increased. Body mass index (P = 0.87), age (P = 0.38), complication rate (P = 0.16), operating time (P = 0.78) and estimated blood loss (P = 0.98) did not change. Decreases in ischemia time corresponded with revised goals in 2011 and early vascular unclamping with the omission of cortical renorrhaphy in selected patients. A multivariable analysis found nephrometry score, tumor diameter, cortical renorrhaphy and year of surgery to be significant predictors of WIT.

Conclusions: Adoption of robotic assistance for a surgeon experienced with laparoscopic surgery was associated with low complication rates even during the initial cases of robot-assisted partial nephrectomy. Ischemia time decreased while no significant changes in blood loss, operating time or complications were seen. The largest decrease in ischemia time was associated with adopting evidence-based goals and new techniques, and was not felt to be related to a learning curve.

No MeSH data available.


Related in: MedlinePlus

Scatter plot of warm ischemia time (WIT) versus operative date for the laparoscopic robot-assisted partial nephrectomies. Surgeries are stratified by goal for maximum WIT (30 min, 20 min, 20 min with omission of cortical renorrhaphy)
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Figure 3: Scatter plot of warm ischemia time (WIT) versus operative date for the laparoscopic robot-assisted partial nephrectomies. Surgeries are stratified by goal for maximum WIT (30 min, 20 min, 20 min with omission of cortical renorrhaphy)

Mentions: Comparing WIT with operative date, the surgeries were stratified by the surgeon's goal concerning maximum WIT during the time of operation [Figure 3]. Between 2007 and April 2011, the mean WIT was 25.4 min, while the mean WIT between April 2011 and June 2013 was 19.1 min. For the LRPNs performed between July 2013 and April 2014, cortical renorrhaphy was omitted in 14 (31.8%) patients; the mean WIT during this time was 15.7 min. A single-factor ANOVA found the differences in WITs between these groups to be statistically significant (P < 0.01).


The learning curve and factors affecting warm ischemia time during robot-assisted partial nephrectomy.

Dube H, Bahler CD, Sundaram CP - Indian J Urol (2015 Jul-Sep)

Scatter plot of warm ischemia time (WIT) versus operative date for the laparoscopic robot-assisted partial nephrectomies. Surgeries are stratified by goal for maximum WIT (30 min, 20 min, 20 min with omission of cortical renorrhaphy)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4495497&req=5

Figure 3: Scatter plot of warm ischemia time (WIT) versus operative date for the laparoscopic robot-assisted partial nephrectomies. Surgeries are stratified by goal for maximum WIT (30 min, 20 min, 20 min with omission of cortical renorrhaphy)
Mentions: Comparing WIT with operative date, the surgeries were stratified by the surgeon's goal concerning maximum WIT during the time of operation [Figure 3]. Between 2007 and April 2011, the mean WIT was 25.4 min, while the mean WIT between April 2011 and June 2013 was 19.1 min. For the LRPNs performed between July 2013 and April 2014, cortical renorrhaphy was omitted in 14 (31.8%) patients; the mean WIT during this time was 15.7 min. A single-factor ANOVA found the differences in WITs between these groups to be statistically significant (P < 0.01).

Bottom Line: The learning curve was defined as the number of procedures needed to reach the targeted goal for WIT, which most recently was 20 min.Body mass index (P = 0.87), age (P = 0.38), complication rate (P = 0.16), operating time (P = 0.78) and estimated blood loss (P = 0.98) did not change.A multivariable analysis found nephrometry score, tumor diameter, cortical renorrhaphy and year of surgery to be significant predictors of WIT.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.

ABSTRACT

Introduction: The learning curve for robotic partial nephrectomy was investigated for an experienced laparoscopic surgeon and factors associated with warm ischemia time (WIT) were assessed.

Materials and methods: Between 2007 and 2014, one surgeon completed 171 procedures. Operative time, blood loss, complications and ischemia time were examined to determine the learning curve. The learning curve was defined as the number of procedures needed to reach the targeted goal for WIT, which most recently was 20 min. Statistical analyses including multivariable regression analysis and matching were performed.

Results: Comparing the first 30 to the last 30 patients, mean ischemia time (23.0-15.2 min, P < 0.01) decreased while tumor size (2.4-3.4 cm, P = 0.02) and nephrometry score (5.9-7.0, P = 0.02) increased. Body mass index (P = 0.87), age (P = 0.38), complication rate (P = 0.16), operating time (P = 0.78) and estimated blood loss (P = 0.98) did not change. Decreases in ischemia time corresponded with revised goals in 2011 and early vascular unclamping with the omission of cortical renorrhaphy in selected patients. A multivariable analysis found nephrometry score, tumor diameter, cortical renorrhaphy and year of surgery to be significant predictors of WIT.

Conclusions: Adoption of robotic assistance for a surgeon experienced with laparoscopic surgery was associated with low complication rates even during the initial cases of robot-assisted partial nephrectomy. Ischemia time decreased while no significant changes in blood loss, operating time or complications were seen. The largest decrease in ischemia time was associated with adopting evidence-based goals and new techniques, and was not felt to be related to a learning curve.

No MeSH data available.


Related in: MedlinePlus