ABSTRACT

Objective:

The robotic platform has become the most accessible minimally invasive surgery, even for surgeons with no previous training in laparoscopy. Partial nephrectomy is a well-established procedure that is highly complex and requires a long learning curve. To describe the learning curve of robotic assisted partial nephrectomy (RAPN) for a single surgeon with little previous experience in laparoscopy.

Materials and Methods:

This was a retrospective study with a prospective collection of data from 58 patients undergoing RAPN by a single surgeon. Variables regarding the patient, tumor, R.E.N.A.L score, and perioperative complications were analyzed in addition to factors connected with “Trifecta”. Trifecta was defined as ischemia time 25 min, negative surgical margin, and absence of severe complications (Clavien >2). A proctor followed the surgery, making small interventions during the first 8 cases.

Results:

The mean age of the patients was 54.5 years (18-84 years), the mean tumor size was 31 mm (8-115 mm), and the surgery was performed within a mean ischemia time of 22 min. All the anatomopathological tests showed negative surgical margins and no angiolymphatic invasion. Trifecta was achieved in 86.2% of the cases.

Conclusion:

RAPN presents good functional and oncological outcomes; it is safe and effective, even for surgeons transitioning directly from the open technique to the robotic one.