Introduction

The surgical robot offers three-dimensional vision, tremor filtering, improved dexterity, increased visualization and an ergonomic setting to enhance surgeon comfort and precision. However, the surgeon is physically separated from the patient. As a result, it necessarily mandated the presence of an assistant surgeon who ensures the smooth running of the intervention. This current study aimed to investigate the impact of the assistant surgeon’ s experience on peri-operative outcomes of robotic partial nephrectomy (RPN)._x000D_

Methods

We performed a retrospective analysis of 221 patients who underwent RPN for a small renal tumour at a single institution. All RPN were performed by two experienced surgeons. Patients were divided into two groups according to the level of experience of the assistant surgeon. A junior level assistant was defined as a resident in his/her three first post-graduate years (PGY)(junior group). Senior-level assistant was defined as a resident in its fourth or fifth post-graduate year (senior group). Peri-operative parameters were compared between the two groups. Multivariate analyses were performed using linear and logistic regression models to seek for predictors of main perioperative outcomes._x000D_

Results

There were 106 RPN involving a junior assistant and 115 RPN involving a senior assistant. The patients characteristics were comparable in both groups. Operative time (OT) and length of stay were longer in the junior group (165 vs. 146 min; p < 0.003, 5.3 vs. 4.2; p = 0.04 respectively). Junior group was associated with an increased risk of positive surgical margin (9% vs 2%; p=0.03). There were not statistically significant differences regarding blood loss (386 vs 417 ml;p=0.73), warm ischemia time (16.4 vs 15.8 min;p=0.29) and risk of conversion to an open approach (3.7 vs 6.7%;p=0.37) between junior and senior groups. The incidence of post-operative complications was comparable between the two groups (11.3 vs 6%; p=0.35). In multivariable analysis that adjusted for the effect of tumour complexity, tumour size, ASA classification and anticoagulant therapy, junior group was significantly associated with a longer OT ([beta]=0,23;p=0,001), positive surgical margin rates (OR=10.8;p=0.009) and length of stay ([beta]=0,13;p=0,05)_x000D_

Conclusions

The results of the present study suggest that the experience of the assistant surgeon influences the peri-operative outcomes of robotic partial nephrectomy, notably operative time and positive surgical margins rate._x000D_

Funding

none