Does teaching of robotic partial nephrectomy affect renal function and perioperative outcomes?

Details

Serval ID
serval:BIB_31F9EB85291E
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Does teaching of robotic partial nephrectomy affect renal function and perioperative outcomes?
Journal
Urologic oncology
Author(s)
Cerantola Y., Ploussard G., Kassouf W., Anidjar M., Bladou F.
ISSN
1873-2496 (Electronic)
ISSN-L
1078-1439
Publication state
Published
Issued date
05/2017
Peer-reviewed
Oui
Volume
35
Number
5
Pages
227-233
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Partial nephrectomy (PN) represents the treatment of choice for localized renal tumor<7cm. Minimally invasive approaches are considered standard of care in many institutions. Maintaining acceptable warm ischemic time (WIT) while teaching robotic PN (RPN) remains challenging. The goal of the present study was to assess the effect of teaching RPN on WIT and renal function in patients undergoing RPN.
Patients undergoing RPN for cT1-T2 renal tumors were included. RENAL nephrometry score was used to adjust for tumor complexity. Glomerular filtration rates (GFR) were determined preoperatively, at day 2 and at ≥3-month follow-up. Patients in whom the attending surgeon (staff) performed tumorectomy and renorraphy were compared with those in whom the fellow performed these steps. Primary outcomes were WIT and GFR decrease at follow-up visit. Morbidity and margin positivity represented secondary outcomes.
Overall, 69 patients (46 "staff" vs. 23 "fellow") were included. Patient׳s characteristics did not differ significantly between the 2 groups. In particular, RENAL score and preoperative GFR were similar between both groups. Mean WIT was 22±9 in the staff and 24±7 in the fellow group (P = 0.09). At follow-up, a GFR reduction of 9% was observed in the staff group vs. 13% in the fellow group (P = 0.38). Complication rates (13% vs. 17%, P = 0.63) and positive margins (9% vs. 4%, P = 0.47) did not differ significantly between staff and fellow.
In our experience, teaching RPN with a strict supervision and stepwise standardized procedure was oncologically and functionally safe after 3 to 6 months of follow-up.

Keywords
Aged, Fellowships and Scholarships, Female, Glomerular Filtration Rate, Humans, Kidney Neoplasms/pathology, Kidney Neoplasms/physiopathology, Kidney Neoplasms/surgery, Male, Margins of Excision, Medical Staff, Hospital, Middle Aged, Neoplasm Staging, Neoplasm, Residual, Nephrectomy/adverse effects, Nephrectomy/education, Nephrectomy/methods, Operative Time, Postoperative Period, Preoperative Period, Robotic Surgical Procedures/adverse effects, Robotic Surgical Procedures/education, Warm Ischemia, Fellow, Partial nephrectomy, Robot, Teaching, Warm ischemia time
Pubmed
Web of science
Create date
24/01/2017 19:29
Last modification date
20/08/2019 14:17
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