Does the Level of Assistant Experience Impact Operative Outcomes for Robot-Assisted Partial Nephrectomy?
J Endourol
; 31(1): 38-42, 2017 01.
Article
em En
| MEDLINE
| ID: mdl-27806631
ABSTRACT
PURPOSE:
A skilled assistant surgeon is presumed necessary during robot-assisted partial nephrectomy (RAPN) to minimize warm ischemia time (WIT) and to facilitate complex renorrhaphy. Studies observing impact of resident participation have focused on robotic prostatectomies, showing no impact on core surgical outcomes. Herein, we evaluated the level of experience of the bedside assistant and its impact on perioperative outcomes in RAPN. MATERIALS ANDMETHODS:
All RAPN cases in our healthcare system from January 2011 to December 2013 were retrospectively reviewed. The cases were divided into teaching and nonteaching hospitals. There were 18 fellowship-trained attending surgeons. At teaching hospitals, surgeries were performed by an attending physician and postgraduate year (PGY)-2 or PGY-3 resident at bedside; at nonteaching hospitals, surgeries were performed by two attending surgeons. We compared age, gender, body mass index, Charlson comorbidity index, operative difficulty by R.E.N.A.L. nephrometry score, and operative outcomes (WIT, estimated blood loss, operative time (OT), positive margin rate, length of stay (LOS), postoperative glomerular filtration rate, and readmission rate).RESULTS:
Of the 170 patients captured, 162 had R.E.N.A.L. nephrometry score and WIT 112 from teaching hospitals and 50 from nonteaching hospitals. Patient characteristics were equivalent between both cohorts with the exception of the R.E.N.A.L. score, which was higher (6.3 vs 5.7, p = 0.046) in the teaching hospitals cohort. Regarding operative outcomes, we noted an overall increase in LOS by 1 day (p = 0.001) and OT by 16 minutes (p = 0.011) in the teaching hospitals.CONCLUSION:
We observed that increased LOS was the only clinically relevant measure negatively impacted by resident physician involvement during RAPN.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Procedimentos Cirúrgicos Robóticos
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Cirurgiões
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Nefrectomia
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Nefrologia
Tipo de estudo:
Observational_studies
Limite:
Adult
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Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2017
Tipo de documento:
Article