Perioperative Outcomes Following Robot-Assisted Partial Nephrectomy For Renal Cell Carcinoma According To Surgeon Generation

Abstract Objective: The constitutional experience with robot-assisted partial nephrectomy (RAPN) associates with better surgical outcomes. Then, surgeon’s generation may impact on surgical outcomes. We evaluated the perioperative outcomes of RAPN between first- and second-generation surgeons according to the surgeon’s experience.Methods: This study included 529 patients who underwent RAPN for renal cell carcinoma from January 2013 to November 2018. Four specific surgeons performed the surgery. The patients were divided into two groups according to the surgeon: first-generation and second-generation. To reflect the learning curve of RAPN, the surgical outcomes of each case (1-50, 51-100, 101-150) were evaluated between groups. Results: Although significant differences in patient and tumor characteristics were not observed between the two groups, there was a trend of a higher rate of high complexity tumors in the first-generation group than in the second-generation group, although not statistically significant. The second-generation group had a shorter operation time in cases 1-50 (169 min vs. 188 min, p = 0.0001), 51-100 (145 min vs. 169 min, p = 0.008), and 101-150 (142 min vs. 165 min, p = 0.009), than the first-generation group. Although shorter WIT and higher trifecta achievement were observed in the second-generation group compared to the first-generation group between 1 to 50 cases, the difference was not noted between 51-100 cases and 101-150 cases. Conclusion: Second-generation surgeons had better surgical outcomes than first-generation surgeons, especially during the early experience period, which might result from their assistant experience, sophisticated surgical procedures refined by the first-generation, and the first-generation surgeon’s introduction.