Mp73-10 Learning Curve for Single-Port Robot-Assisted Urological Surgery: Implications for Surgical Adoption

You have accessJournal of UrologySurgical Technology & Simulation: Training & Skills Assessment (MP73)1 May 2024MP73-10 LEARNING CURVE FOR SINGLE-PORT ROBOT-ASSISTED UROLOGICAL SURGERY: IMPLICATIONS FOR SURGICAL ADOPTION Antony A. Pellegrino, Donato Cannoletta, Ruben Sauer Calvo, Juan Torres Anguiano, Francesco Pellegrino, Luca Morgantini, Alberto Briganti, and Simone Crivellaro Antony A. PellegrinoAntony A. Pellegrino , Donato CannolettaDonato Cannoletta , Ruben Sauer CalvoRuben Sauer Calvo , Juan Torres AnguianoJuan Torres Anguiano , Francesco PellegrinoFrancesco Pellegrino , Luca MorgantiniLuca Morgantini , Alberto BrigantiAlberto Briganti , and Simone CrivellaroSimone Crivellaro View All Author Informationhttps://doi.org/10.1097/01.JU.0001009564.26544.1c.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: With the introduction of the daVinci Single-Port (SP), all surgeons considering adoption will experience (EXP) a learning curve (LC). No data are available assessing the LC of common urological procedures using the SP. We investigated the effect of surgeon EXP on perioperative outcomes after Nephrectomy (NP), Simple (RASP) and Radical (RARP) Prostatectomy. METHODS: 387 pts from a single center undergoing SP surgery by a single surgeon established when we began using this platform (Dec. 2018). We calculated surgeon EXP as overall EXP (number of SP procedures performed prior to index surgery), and specific procedure EXP (number of times the surgeon had performed that surgery with SP prior to index surgery). We tested whether overall experience or specific procedure experience were associated with the risk of complications and operating room (OR) time with multivariate models (MVA) adjusted for age, ASA score, BMI, and procedure (NP vs RASP vs RARP). Finally, we plotted the risk of complications by surgeon overall experience and procedure, using the LOWESS function. RESULTS: Overall, 172 (44%), 53 (14%), and 162 (42%) pts underwent RARP, RASP, and NP, respectively. 56% had an ASA score ≥3. In patients which underwent NP, 32% underwent radical NP, 61% partial NP and 7% nephroureterectomy. Overall, 17% and 6% experienced any grade and severe complications (Clavien-Dindo ≥3), respectively and 31 (8%) required readmission. At MVA, both overall and procedure specific EXP were associated with a lower risk of overall complications (odds ratio [OR] for a procedure specific EXP increase of 10 procedures: 0.83, Confidence interval [CI]: 0.76-0.89; OR for an overall EXP increase of 10 procedures: 0.93, CI: 0.90-0.96). Furthermore, the overall EXP was also associated with a reduction in the OR time (beta: -3.9, CI: -4.9, -2.9). Figure 1 shows that the risk of complication reached a plateau at 30, 70 and 150 cases for RASP, RARP and NP, respectively. CONCLUSIONS: The SP platform has a unique LC, both inherent to the novel platform, and procedure specific characteristics. For surgeons approaching the SP for the first time, RASP and RALP possess the earliest LC plateau, and hence should be approached first, with renal surgery attempted only once the surgeon has become accustomed to the SP. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1186 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Antony A. Pellegrino More articles by this author Donato Cannoletta More articles by this author Ruben Sauer Calvo More articles by this author Juan Torres Anguiano More articles by this author Francesco Pellegrino More articles by this author Luca Morgantini More articles by this author Alberto Briganti More articles by this author Simone Crivellaro More articles by this author Expand All Advertisement PDF downloadLoading ...