Robot assisted kidney transplant (RAKT) is a good option for obese recipients. Our group first performed this procedure in 2009 and nowadays the experience includes 4 different surgeons as first operator. Our minimally invasive training lab with 2 dedicated robotic systems has provided training to the transplant team during the transition from open to RAKT. A complete learning curve evaluation was performed. The aim was to measure if in our robotic transplant program, the inclusion of a new surgeon had a negative impact on surgical performance.

Our 202 RAKTs were evaluated using a prospective database. All surgeons were proficient in open kidney transplant before starting the robotic procedure. The first surgeon (PCG) has extensive robotic experience, while the others did robotic nephrectomies only. Operative time, warm ischemia time, estimated blood loss and surgical complications were used as outcomes. Eighteen patients were excluded from the time analysis due to associated surgical procedures: 8 hernia repairs, 1 native neprhectomy, 1 salpingo-oophorectomy, 5 bariatric procedures and 3 splenectomies. One more patient was excluded due to a double arterial anastomosis.

A CUSUM analysis based on warm ischemia time demonstrated no learning curve for vascular anastomosis; personal mean time varied among surgeons, but without any trend. The CUSUM of the total operative time showed that, when a new surgeon started performing RAKT, the process was always “under control”. A single case number to reach a stable proficiency was not possible to determine. Surgical complications were distributed homogeneally in the series, not differing considering the whole series or the single surgeon. The same distrubution was observed for the extimated blood loss. A sort of learning curve was measurable for the entire team experience instead of for the single surgeon; this suggests that for expert surgeons, starting a known procedure with a robotic approach, being part of the team can positively impact on performance (even if not done as first surgeon). This preliminary result has to be cross checked looking at different procedures.

In summary, a CUSUM analysis of our experince with RAKT measured that when a new surgeon started to perform it, there was no negative impact on patients.

CITATION INFORMATION: Gheza F., Di Bella C., Giulianotti P., Oberholzer J., Benedetti E., Tzvetanov I. Involvement of Additional Surgeons in Robot Assisted Kidney Transplantation Does Not Affect Surgical Outcomes, in the Context of a Structured Robotic Surgery Program. Results from a CUSUM Analysis Am J Transplant. 2017;17 (suppl 3).

« Back to 2018 American Transplant Congress