Category: Laparoscopic/ Robotic: Other

MP25-14 - Is warm ischemia time an indicator of surgeons’ learning curve progression in robotic partial nephrectomy: a proposal for novel indexes.

Sun, Sep 23
10:00 AM - 12:00 PM

Introduction & Objective :

Series on robotic partial nephrectomy (RPN) report several outcomes that may reflect the quality of surgery and surgeons’ skill progression over time. These variables include warm ischemia time (WIT), duration of surgery, estimated blood loss, and postoperative creatinine change. As more experience is gained, more challenging cases are added to the cohort with larger tumors, more complex RENAL scores, and larger BMI. We set out to evaluate which factors may truly reflect the progression of skill associated with RPN over the years.


Methods : We reviewed a prospectively maintained database of RPN. We included only cases of three urologists who shifted from laparoscopic to RPN in our institution (HMA, WKA, MFA). We plotted the change in their patients’ characteristics and operative performance over years. To compensate for the change in tumor complexity, we evaluated two novel indices as indicators of surgical skill progression: the WIT/RENAL score index and WIT/tumor size index.  We used SPSS version 25 for statistical analysis. Dates of surgery were converted into an ordered rank and plotted against the scale variables using linear regression and curve estimation functions. 


Results :

Between Oct-08 and Jun-17 a total of 56 patients (30 males, 26 females) had RPN and met the inclusion criteria. No significant change was found (Median ± SD) in BMI (30.3±5.7, p=0.07), RENAL score (6±1.8, p=0.39), or tumor size (max diameter 3±1 cm, p=0.06).  No significant change was seen in WIT (17±4.3 min, p=0.11, Fig. 1), operative duration (147.5±33.2 min, p=0.5), blood loss (200±109.3 ml, p=0.7), or postoperative creatinine level (p=0.5). There was a significant decrease in the WIT/RENAL score index (0.036, Fig. 2) and WIT/tumor size index (p=0.017).


Conclusions : The novel indexes of WIT/RENAL score and WIT/tumor size may reflect more accurately the surgeon’s skill progression for RPN in comparison with other benchmarks of surgical performance.

Raouf M. Seyam

Urologist
King Faisal Specialist Hospital and Research Center
Riyadh, Ar Riyad, Saudi Arabia

Raouf M. Seyam
M.B., Ch.B.; Ms. Sc. (Urology); M.D. (Urology).
Professor and Consultant of Urology
P.O. Box 3354, Riyadh, 11211, Saudi Arabia
Mobile: +966 509875404
E-Mail: rmseyam@yahoo.com
Interests and expertise: Adult Urology, Erectile dysfunction and Male Infertility, Genitourinary malignancy, Endourology and Neurourology and Urodynamics. Research in general urology with emphasis on andrology. Experimental animal research and microsurgical techniques.
Saudi Council Registration: Consultant of Urology, 02-R-M-2008
Present titles:
Professor of Urology (Retired), Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
Assistant Consultant Urologist, King Faisal Specialist Hospital and Research Center, Riyadh, KSA.
Adjunct Associate Professor, Al Faisal University, Faculty of Medicine, Riyadh, KSA.

Waleed K. Alkhudair

Consultant of Urology
King Faisal Specialist Hospital and Research Center
Riyadh, Ar Riyad, Saudi Arabia

Hassan M. Alzahrani

Consultant of Urology
King Faisal Specialist Hospital and Research Center
Riyadh, Ar Riyad, Saudi Arabia

Raed A. Azhar

Assistant Professor of Urology
King Abdulaziz University
Jeddah, Makkah, Saudi Arabia

Khalid I. Alothman

Consultant of Urology
King Faisal Specialist Hospital and Research Center
Riyadh, Ar Riyad, Saudi Arabia

Mohammed F. Alotaibi

Consultant of Urology
King Faisal Specialist Hospital and Research Center
Riyadh, Ar Riyad, Saudi Arabia