Category: Laparoscopic/ Robotic: Other
Introduction & Objective : Robotic assisted laparoscopy was first approved by the FDA in 2000 for general laparoscopic procedures. The robotic assisted laparoscopic retroperitoneal lymph node dissection (R-RPLND) was developed in 2009 and has been practiced at the Naval Medical Center San Diego (NMCSD) by two fellowship trained robotic surgeons. We hypothesized that surgical times and operative complications would decrease as surgeons became more facile with R-RPLND techniques.
Methods : We retrospectively reviewed all 53 R-RPLNDs performed at NMCSD between 2009 and 2016 by two experienced robotic surgeons. Linear regression was used to analyze independent predictors of set-up time and surgical time. Logistic regression was used to analyze overall complications. Variables included as independent predictors were: case sequence number, no chemo vs post-chemo R-RPLNDs, unilateral vs bilateral R-RPLNDs, surgeon, and BMI. Multi-variate analysis was conducted using forward step-wise progression to build the model. Predictors were eliminated sequentially if p>0.20 in the multi-variate model. Statistical significance was established at p=0.05.
Results : The only significant predictor of set-up time on multivariate analysis was case sequence number (p=0.044). For surgical time, significant predictors on both univariate and multivariate analysis were no chemo vs post-chemo (p=<0.001) and unilateral vs bilateral R-RPLNDs (p=0.019). Case sequence had no relationship to surgical time (Figure). For overall complications, the only significant predictor on both univariate and multivariate analysis was sequence number (p=0.028); all other factors were not significant.
Conclusions : Room set-up time for R-RPLNDs improves with experience. Operative time is only predicted by no chemo vs post-chemo and unilateral vs bilateral R-RPLNDs; there was no learning "curve" with respect to surgical time. However, complications have decreased as more experience with this procedure is gained. These findings suggest that this procedure could be adopted with little additional training by experienced robotic surgeons.
Nicholas Rocco– Urology Resident, Naval Medical Center San Diego, La Jolla, California
Matthew Christman– San Diego, California
Sean Stroup– San Diego, California
Michael Marshall– San Diego, California
Patrick Scarborough– N/A, Guam
Sophia Schermerhorn– Bethesda, Maryland
James L’Esperance– Tulsa, Oklahoma