Pd33-04 prior surgical experience and the impact on perioperative outcomes in robot-assisted partial nephrectomy: a multicenter analysis with 2,500 patients

You have accessJournal of UrologyCME1 May 2022PD33-04 PRIOR SURGICAL EXPERIENCE AND THE IMPACT ON PERIOPERATIVE OUTCOMES IN ROBOT-ASSISTED PARTIAL NEPHRECTOMY: A MULTICENTER ANALYSIS WITH 2,500 PATIENTS Nina N. Harke, Frank Schiefelbein, Andreas Schneller, Georg Schoen, Clemens G. Wiesinger, Jacob Pfuner, Boris A. Hadaschik, Jan Philipp Radtke, Mulham Al Nader, Daniar Osmonov, Ahmed Eraky, Burkhard Ubrig, Simon Gloger, Jorn H. Witt, Nikolaos Liakos, Christian Wagner, Florian Imkamp, Stephan Huusmann, Markus A. Kuczyk, Stefan Siemer, Michael Stoeckle, and Philip Zeuschner Nina N. HarkeNina N. Harke More articles by this author , Frank SchiefelbeinFrank Schiefelbein More articles by this author , Andreas SchnellerAndreas Schneller More articles by this author , Georg SchoenGeorg Schoen More articles by this author , Clemens G. WiesingerClemens G. Wiesinger More articles by this author , Jacob PfunerJacob Pfuner More articles by this author , Boris A. HadaschikBoris A. Hadaschik More articles by this author , Jan Philipp RadtkeJan Philipp Radtke More articles by this author , Mulham Al NaderMulham Al Nader More articles by this author , Daniar OsmonovDaniar Osmonov More articles by this author , Ahmed ErakyAhmed Eraky More articles by this author , Burkhard UbrigBurkhard Ubrig More articles by this author , Simon GlogerSimon Gloger More articles by this author , Jorn H. WittJorn H. Witt More articles by this author , Nikolaos LiakosNikolaos Liakos More articles by this author , Christian WagnerChristian Wagner More articles by this author , Florian ImkampFlorian Imkamp More articles by this author , Stephan HuusmannStephan Huusmann More articles by this author , Markus A. KuczykMarkus A. Kuczyk More articles by this author , Stefan SiemerStefan Siemer More articles by this author , Michael StoeckleMichael Stoeckle More articles by this author , and Philip ZeuschnerPhilip Zeuschner More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002584.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Effects of prior surgical experience on perioperative results in robotic radical prostatectomy have been indicated, but only little is known about this association in robotic partial nephrectomy (RPN). METHODS: In this retrospective study with 25 surgeons from 8 robotic centers, the results of 2,548 RPN between 2007 and 2021 were analyzed. For each surgeon, the consecutive RPN cases from the individual beginning were included as well as the numbers of prior kidney (open, laparoscopic), pelvic (open, laparoscopic, robotic) and other robotic surgeries. The impact of prior surgical experience (per 100 cases) on warm ischemia time (WIT), major complications and MIC score (no positive surgical margins, WIT ≤20 min, no major complications) was assessed by regression analyses accounting for age, gender, BMI, ASA, PADUA score and experience in RPN (per case). RESULTS: A median of 145 open and 5 laparoscopic kidney surgeries as well as 500 open, 3 laparoscopic and 100 robotic pelvic surgeries and 23 other robotic surgeries were performed per surgeon prior to the first RPN. Patients had a median BMI of 27 kg/m2 and ASA score of 2. The median PADUA score was 8. Median skin-skin-time was 152 min; WIT was 13 min; 12% off-clamp resections. MIC criteria were fulfilled in 73% of cases with 8% major complications.Multivariate regression analysis showed lower MIC rates with increasing BMI (odds ratio (OR) 0.978, p=0.021) and PADUA score (OR 0.769, p<0.001) and improvement with growing individual experience in RPN (OR per case 1.004, p<0.001), prior laparoscopic kidney surgeries (OR per 100 surgeries 1.160, p=0.013), open pelvic (OR 1.084, p<0.001) and robotic pelvic surgeries (OR 1.129, p=0.020). A positive impact for a higher number of open kidney surgeries was not observed. WIT improved with surgical experience in RPN, prior laparoscopic kidney surgeries, open and robotic pelvic surgeries (each p<0.001) and was negatively influenced by higher PADUA scores. Major complication rates increased with higher ASA (OR 1.478, p=0.002) and PADUA score (OR 1.182, p<0.001) and decreased with higher experience in RPN (OR 0.995, p<0.001) and prior robotic pelvic surgeries (OR 0.718, p<0.001). CONCLUSIONS: For the first time, this large multicenter cohort illustrates an association of prior surgical experience with perioperative outcomes in RPN. While we could not detect a positive impact of a vast experience in open kidney surgery, a higher number of prior laparoscopic kidney and robot-assisted pelvic surgeries may be beneficial. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e553 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nina N. Harke More articles by this author Frank Schiefelbein More articles by this author Andreas Schneller More articles by this author Georg Schoen More articles by this author Clemens G. Wiesinger More articles by this author Jacob Pfuner More articles by this author Boris A. Hadaschik More articles by this author Jan Philipp Radtke More articles by this author Mulham Al Nader More articles by this author Daniar Osmonov More articles by this author Ahmed Eraky More articles by this author Burkhard Ubrig More articles by this author Simon Gloger More articles by this author Jorn H. Witt More articles by this author Nikolaos Liakos More articles by this author Christian Wagner More articles by this author Florian Imkamp More articles by this author Stephan Huusmann More articles by this author Markus A. Kuczyk More articles by this author Stefan Siemer More articles by this author Michael Stoeckle More articles by this author Philip Zeuschner More articles by this author Expand All Advertisement PDF downloadLoading ...