Total robotic surgical volume influences outcomes of low-volume robotic-assisted partial nephrectomy over an extended duration

Introduction: The objective of this study was to examine the sur-geon's experience of low-volume robotic-assisted partial nephrec-tomy (RAPN) over an extended duration, and whether a high-vol-ume fellowship training influenced the outcomes. Methods: Data on all RAPN at a tertiary center performed by a uro-oncologist were retrospectively collected. The surgeon experi-ence was assessed by examining perioperative outcomes among three groups of consecutive patients (first=14, second=14, third=15 patients, respectively). Results: Between February 2014 and February 2020, 45 RAPNs were performed out of a total of 200 robotic procedures. The medi-an tumor size was 3 cm, and 28 (65%) patients had a R.E.N.A.L nephrometry score (RNS) >= 7. The median operative time and warm ischemia time (WIT) were 190 and 16 minutes, respectively. The median estimated blood loss (EBL) was 100 mL. Two (4%) patients had a positive surgical margin (PSM). Overall, five (12%) compli-cations were recorded. All except one were minor (Clavien I-II). The median followup was 26.2 months. Trifecta and pentafecta were achieved in 40 (93%) and 27 (81.8%) patients, respectively. Increased surgeon experience was significantly associated with a shorter operative time and less EBL. Furthermore, there was an independent association between surgeon experience and opera-tive time and EBL, and between RNS and operative time and WIT. Conclusions: With fellowship training and subsequent adequate total number of robotic procedures during practice, it is possible to perform RAPN with favorable perioperative outcomes in the setting of low-volume of cases over an extended duration.