Introduction

Surgical teaching may potentially influence patient care. A safe, high-quality surgery practice requires dedicated and specialized training commonly acquired during a fellowship. The purpose of this study was to determine whether robot-assisted partial nephrectomy (RAPN) may be taught to fellows without influencing operative outcomes.

Methods

We analyzed 276 patients who underwent RAPN for a small renal tumour. We stratified our cohort in two groups according to the involvement or not of a surgeon in training during the procedure: expert surgeon operating alone (expert group) or surgeon in training operating under the supervision of the expert surgeon (fellow group). Patients who underwent RAPN during the early learning curve of the expert surgeon (first 60 NPRA) were excluded. Peri-operative data were compared between the two groups. Linear and logistic regression analyses were performed to assess the impact of fellows involvement on perioperative and postoperative outcomes. _x000D_

Results

Fellows were involved in a total of 89 procedures (41 %) and 127 (59 %) of cases were done by the expert surgeon alone. The patients characteristics were comparable in both groups. Operative time (OT) and warm ischemia time (WIT) were longer in the fellow group (188.2 vs. 129.9 min; p < 0.001, and 17.7 vs. 14.8 min; p<0.001, respectively) as was LOS (5 vs. 4.3; p = 0.05). Patients in the fellow group had a higher blood loss (491.8 vs.409.6 ml ; p = 0.01) but this had no impact on the transfusion rate (14 vs. 11%; p =0.43). Positive surgical margin rates were similar between expert and fellow groups (6.9 vs. 5.8%; p = 0.78). The major complications rate was higher in the fellow group (12%) but this difference did not reach statistical significance (p= 0.12). In multivariable analysis, fellow involvement was predictive of increased WIT ([beta]=0.21;p<0.004) and OT ([beta]=0.49;p<0.0001) but was not associated with LOS ([beta]=0.12, p=0.11).

Conclusions

Fellows involvement in RAPN is associated with increased OT and WIT. However, it does not adversely affect complication rates or surgical margins._x000D_

Funding

none