EAU 2018: Analysis of the Impact of Assistant Surgeon Experience on Peri‐Operative Outcomes of Robotic Partial Nephrectomy

Copenhagen, Denmark (UroToday.com) The Da-Vinci robot offers three-dimensional vision, tremor filtering, improved dexterity, increased visualization and an ergonomic setting to enhance surgeon comfort and precision. However, the surgeon is physically separated from the patient. As a result, it mandates the presence of an assistant surgeon who ensures the smooth running of the intervention. This current study aimed to investigate the impact of the assistant surgeon’s experience on peri-operative outcomes of robotic partial nephrectomy (RPN).

The authors performed a retrospective analysis of 221 patients who underwent RPN for a small renal tumour at a single institution. All RPNs were performed by two experienced surgeons. Patients were divided into two groups according to the level of experience of the assistant surgeon. A junior level assistant was defined as a resident in his/her three first post-graduate years (PGY) (junior group). Senior-level assistant was defined as a resident in his/her fourth or fifth post-graduate year (senior group). Peri-operative parameters were compared between the two groups. Multivariable analyses were performed using linear and logistic regression models to seek for predictors of main perioperative outcomes.

There were 106 RPN involving a “junior” assistant and 115 RPN involving a senior assistant. The patients’ characteristics were comparable in both groups. Operative time (OT) and length of stay were longer in the junior group (165 vs. 146 min; p < 0.003, 5.3 vs. 4.2; p = 0.04 respectively). Junior group was associated with an increased risk of positive surgical margin (9% vs 2%; p=0.03). There were not statistically significant differences regarding blood loss (386 vs 417 ml; p=0.73), warm ischemia time (16.4 vs 15.8 min; p = 0.29) and risk of conversion to an open approach (3.7 vs 6.7%; p=0.37) between junior and senior groups. The incidence of post-operative complications was comparable between the two groups (11.3 vs 6%; p=0.35). In multivariable analysis that adjusted for the effect of tumour complexity, tumour size, ASA classification and anticoagulant therapy, junior group was significantly associated with a longer OT (b=0,23; p=0,001), positive surgical margin rates (OR=10.8; p=0.009) and length of stay (b=0,13; p=0,05).

The results of the present study suggest that the experience of the assistant surgeon influences the peri-operative outcomes of RPN, notably operative time and positive surgical margins rate.

Presented by: Bosquet E, Rennes, MD, University Hospital, Dept. of Urology, Rennes, France

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, twitter: @GoldbergHanan at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark