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Learning curve of a new surgical procedure: Experience from a new center adopting Robotic Kidney transplant.

Login to Access Video or Poster Abstract: MP06-05
Sources of Funding: none

Introduction

Evaluating learning curve of a new procedure is important in order to assess the reproducibility and ease of adoption of the procedure, and also to track progress of an institution adopting the new procedure. This study reports the results and learning curves of robotic kidney transplantation (RKT) with regional hypothermia at a center that recently adopted this procedure._x000D_

Methods

33 patients underwent Vattikuti Urology Institute technique of RKT in Turkey, by surgeons routinely performing robotic surgery and kidney transplantation. Standard KT outcomes were noted with a minimum follow-up of 1 month for all, and compared to the results of an established RKT program in India, who used the same technique of RKT. CUSUM analysis was done to evaluate the learning process. Target values were based on the average values of the established RKT program. Completion of learning curve was defined as anastomosis and rewarming times plateauing within 2 standard deviations (SD) of the target value.

Results

All patients underwent RKT successfully. The mean console, warm ischemia, and rewarming times were 187±34.6 min, 1.89±0.5 min, and 58.0±17.8 min respectively. Arterial, venous, and ureterovesical anastomosis times were 19.3±5.9, 21.9±6.8, and 22.5±4.2 min respectively. The median hospital stay was 10 days (6-14 d), and creatinine at discharge was 1.43±5.73 mg/dl. These results differ significantly from the results of the established program with regard to anastomosis times and rewarming time (p<0.05 for all). However, there was no difference in creatinine at discharge (p>0.05) (figure 1a). There was no delayed graft function, no Clavien grade ?3 complications, lymphoceles, vascular or ureteral complications; one wound infection requiring medical management. CUSUM analysis revealed that learning curve lasted for 9 cases with regards to rewarming time, 19 cases for arterial anastomosis, 18 cases for venous anastomosis. No learning curve existed for uretrovesical anastomosis (Figure 1b).

Conclusions

RKT has excellent outcomes, and low complication rates at a center that recently adopted this procedure. It has a short learning curve, and is reproducible. The longer anastomosis times at the start of learning curve do not affect graft function, supporting the hypothesis that regional hypothermia is protective._x000D_

Funding

none

Authors
Sohrab Arora
Volkan Tugcu
Akshay Sood
Mahendra Bhandari
Rajesh Ahlawat
Mani Menon
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