Skill Transfer from Laparoscopic Partial Nephrectomy to the Hugo™ RAS System: A Novel Proficiency Score to Assess Surgical Quality during the Learning Curve
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Collection
2.2. Surgical Technique
2.3. Postoperative Management
2.4. Endpoint, Outcome and Statistical Analysis
3. Results
3.1. Patient Demographic and Preoperative Outcomes
3.2. Perioperative Outcomes
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Mir, M.C.; Derweesh, I.; Porpiglia, F.; Zargar, H.; Mottrie, A.; Autorino, R. Partial Nephrectomy Versus Radical Nephrectomy for Clinical T1b and T2 Renal Tumors: A Systematic Review and Meta-Analysis of Comparative Studies. Eur. Urol. 2017, 71, 606–617. [Google Scholar] [CrossRef]
- De Lorenzis, E.; Palumbo, C.; Cozzi, G.; Talso, M.; Rosso, M.; Costa, B.; Gadda, F.; Rocco, B. Robotics in Uro-Oncologic Surgery. Ecancermedicalscience 2013, 7, 354. [Google Scholar] [CrossRef] [PubMed]
- Carbonara, U.; Simone, G.; Capitanio, U.; Minervini, A.; Fiori, C.; Larcher, A.; Checcucci, E.; Amparore, D.; Crocerossa, F.; Veccia, A.; et al. Robot-Assisted Partial Nephrectomy: 7-Year Outcomes. Minerva Urol. Nephrol. 2021, 73, 540–543. [Google Scholar] [CrossRef]
- Tuderti, G.; Mastroianni, R.; Anceschi, U.; Bove, A.M.; Brassetti, A.; Ferriero, M.; Misuraca, L.; Guaglianone, S.; Costantini, M.; Torregiani, G.; et al. Assessing the Trade-off Between the Safety and Effectiveness of Off-Clamp Robotic Partial Nephrectomy for Renal Masses with a High RENAL Score: A Propensity Score-Matched Comparison of Perioperative and Functional Outcomes in a Multicenter Analysis. Eur. Urol. Focus 2023, 9, 1037–1043. [Google Scholar] [CrossRef] [PubMed]
- Papalia, R.; De Castro Abreu, A.L.; Panebianco, V.; Duddalwar, V.; Simone, G.; Leslie, S.; Guaglianone, S.; Tejura, T.; Ferriero, M.; Costantini, M.; et al. Novel Kidney Segmentation System to Describe Tumour Location for Nephron-Sparing Surgery. World J. Urol. 2015, 33, 865–871. [Google Scholar] [CrossRef] [PubMed]
- Petrozza, V.; Pastore, A.L.; Palleschi, G.; Tito, C.; Porta, N.; Ricci, S.; Marigliano, C.; Costantini, M.; Simone, G.; Di Carlo, A.; et al. Secreted MiR-210-3p as Non-Invasive Biomarker in Clear Cell Renal Cell Carcinoma. Oncotarget 2017, 8, 69551–69558. [Google Scholar] [CrossRef] [PubMed]
- Bradshaw, A.W.; Autorino, R.; Simone, G.; Yang, B.; Uzzo, R.G.; Porpiglia, F.; Capitanio, U.; Porter, J.; Bertolo, R.; Minervini, A.; et al. Robotic Partial Nephrectomy vs Minimally Invasive Radical Nephrectomy for Clinical T2a Renal Mass: A Propensity Score-Matched Comparison from the ROSULA (Robotic Surgery for Large Renal Mass) Collaborative Group. BJU Int. 2020, 126, 114–123. [Google Scholar] [CrossRef]
- Marszalek, M.; Carini, M.; Chlosta, P.; Jeschke, K.; Kirkali, Z.; Knüchel, R.; Madersbacher, S.; Patard, J.J.; Van Poppel, H. Positive Surgical Margins after Nephron-Sparing Surgery. Eur. Urol. 2012, 61, 757–763. [Google Scholar] [CrossRef]
- Napolitano, L.; Orecchia, L.; Giulioni, C.; Carbonara, U.; Tavella, G.; Lizzio, L.; Fimognari, D.; De Palma, A.; Gheza, A.; Grosso, A.A.; et al. The Role of MiRNA in the Management of Localized and Advanced Renal Masses, a Narrative Review of the Literature. Appl. Sci. 2023, 13, 275. [Google Scholar] [CrossRef]
- Larcher, A.; Muttin, F.; Peyronnet, B.; De Naeyer, G.; Khene, Z.E.; Dell’Oglio, P.; Ferreiro, C.; Schatteman, P.; Capitanio, U.; D’Hondt, F.; et al. The Learning Curve for Robot-Assisted Partial Nephrectomy: Impact of Surgical Experience on Perioperative Outcomes. Eur. Urol. 2019, 75, 253–256. [Google Scholar] [CrossRef]
- Glasbey, J.C.; Abbott, T.E.; Ademuyiwa, A.; Adisa, A.; AlAmeer, E.; Alshryda, S.; Arnaud, A.P.; Bankhead-Kendall, B.; Abou Chaar, M.K.; Chaudhry, D.; et al. Elective Surgery System Strengthening: Development, Measurement, and Validation of the Surgical Preparedness Index across 1632 Hospitals in 119 Countries. Lancet 2022, 400, 1607–1617. [Google Scholar] [CrossRef]
- Papalia, R.; Simone, G.; Ferriero, M.; Guaglianone, S.; Costantini, M.; Giannarelli, D.; Maini, C.L.; Forastiere, E.; Gallucci, M. Laparoscopic and Robotic Partial Nephrectomy without Renal Ischaemia for Tumours Larger than 4 Cm: Perioperative and Functional Outcomes. World J. Urol. 2012, 30, 671–676. [Google Scholar] [CrossRef] [PubMed]
- Abboudi, H.; Khan, M.S.; Guru, K.A.; Froghi, S.; De Win, G.; Van Poppel, H.; Dasgupta, P.; Ahmed, K. Learning Curves for Urological Procedures: A Systematic Review. BJU Int. 2014, 114, 617–629. [Google Scholar] [CrossRef] [PubMed]
- Pietersen, P.I.; Hertz, P.; Olsen, R.G.; Møller, L.B.; Konge, L.; Bjerrum, F. Transfer of Skills between Laparoscopic and Robot-Assisted Surgery: A Systematic Review. Surg. Endosc. 2023, 37, 9030–9042. [Google Scholar] [CrossRef]
- Zhang, G.; Wang, B.; Liu, H.; Jia, G.; Tao, B.; Zhang, H.; Wang, C. How Many Cases Are Required to Achieving Early Proficiency in Purely Off-Clamp Robot-Assisted Partial Nephrectomy? Front. Surg. 2024, 10, 1309522. [Google Scholar] [CrossRef] [PubMed]
- Dias, B.H.; Ali, M.S.; Dubey, S.; Krishnaswamy, S.A.; Rao, A.R.; Dubey, D. Impact of Learning Curve on the Perioperative Outcomes Following Robot-Assisted Partial Nephrectomy for Renal Tumors. Indian J. Urol. 2018, 34, 62–67. [Google Scholar] [CrossRef]
- Clavien, P.A.; Barkun, J.; De Oliveira, M.L.; Vauthey, J.N.; Dindo, D.; Schulick, R.D.; De Santibañes, E.; Pekolj, J.; Slankamenac, K.; Bassi, C.; et al. The Clavien-Dindo Classification of Surgical Complications: Five-Year Experience. Ann. Surg. 2009, 250, 187–196. [Google Scholar] [CrossRef] [PubMed]
- Prata, F.; Ragusa, A.; Anceschi, U.; Iannuzzi, A.; Tedesco, F.; Cacciatore, L.; Civitella, A.; Tuzzolo, P.; Cirillo, R.; Callè, P.; et al. Three-Arms off-Clamp Robot-Assisted Partial Nephrectomy with the New Hugo Robot-Assisted Surgery System. BJU Int. 2024, 133, 48–52. [Google Scholar] [CrossRef]
- Prata, F.; Raso, G.; Ragusa, A.; Iannuzzi, A.; Tedesco, F.; Cacciatore, L.; Civitella, A.; Tuzzolo, P.; D’Addurno, G.; Callè, P.; et al. Robot-Assisted Renal Surgery with the New Hugo Ras System: Trocar Placement and Docking Settings. J. Pers. Med. 2023, 13, 1372. [Google Scholar] [CrossRef]
- Wang, A.J.; Bhayani, S.B. Robotic Partial Nephrectomy versus Laparoscopic Partial Nephrectomy for Renal Cell Carcinoma: Single-Surgeon Analysis of >100 Consecutive Procedures. Urology 2009, 73, 306–310. [Google Scholar] [CrossRef] [PubMed]
- Anceschi, U.; Morelli, M.; Flammia, R.S.; Brassetti, A.; Dell’oglio, P.; Galfano, A.; Tappero, S.; Vecchio, E.; Martiriggiano, M.; Luciani, L.G.; et al. Predictors of Trainees’ Proficiency during the Learning Curve of Robot-Assisted Radical Prostatectomy at High- -Volume Institutions: Results from a Multicentric Series. Cent. Eur. J. Urol. 2023, 76, 38–43. [Google Scholar] [CrossRef]
- Saitta, C.; Afari, J.A.; Autorino, R.; Capitanio, U.; Porpiglia, F.; Amparore, D.; Piramide, F.; Cerrato, C.; Meagher, M.F.; Noyes, S.L.; et al. Development of a Novel Score (RENSAFE) to Determine Probability of Acute Kidney Injury and Renal Functional Decline Post Surgery: A Multicenter Analysis. Urol. Oncol. 2023, 41, 487.e15–487.e23. [Google Scholar] [CrossRef] [PubMed]
- Cerrato, C.; Meagher, M.F.; Autorino, R.; Simone, G.; Yang, B.; Uzzo, R.G.; Kutikov, A.; Porpiglia, F.; Capitanio, U.; Montorsi, F.; et al. Partial versus Radical Nephrectomy for Complex Renal Mass: Multicenter Comparative Analysis of Functional Outcomes (Rosula Collaborative Group). Minerva Urol. Nephrol. 2023, 75, 425–433. [Google Scholar] [CrossRef] [PubMed]
- Brassetti, A.; Cacciamani, G.E.; Mari, A.; Garisto, J.D.; Bertolo, R.; Sundaram, C.P.; Derweesh, I.; Bindayi, A.; Dasgupta, P.; Porter, J.; et al. On-Clamp vs. Off-Clamp Robot-Assisted Partial Nephrectomy for CT2 Renal Tumors: Retrospective Propensity-Score-Matched Multicenter Outcome Analysis. Cancers 2022, 14, 4431. [Google Scholar] [CrossRef] [PubMed]
- Ferriero, M.; Brassetti, A.; Mastroianni, R.; Costantini, M.; Tuderti, G.; Anceschi, U.; Bove, A.M.; Misuraca, L.; Guaglianone, S.; Gallucci, M.; et al. Off-Clamp Robot-Assisted Partial Nephrectomy for Purely Hilar Tumors: Technique, Perioperative, Oncologic and Functional Outcomes from a Single Center Series. Eur. J. Surg. Oncol. 2022, 48, 1848–1853. [Google Scholar] [CrossRef]
- White, W.M.; Goel, R.K.; Haber, G.P.; Kaouk, J.H. Robotic Partial Nephrectomy without Renal Hilar Occlusion. BJU Int. 2010, 105, 1580–1584. [Google Scholar] [CrossRef]
- Brassetti, A.; Ragusa, A.; Tedesco, F.; Prata, F.; Cacciatore, L.; Iannuzzi, A.; Bove, A.M.; Anceschi, U.; Proietti, F.; D’Annunzio, S.; et al. Robotic Surgery in Urology: History from PROBOT® to HUGOTM. Sensors 2023, 23, 7104. [Google Scholar] [CrossRef] [PubMed]
- Kim, B.; Chang, A.; Kaswick, J.; Derboghossians, A.; Jung, H.; Slezak, J.; Wuerstle, M.; Williams, S.G.; Chien, G.W. Achieving Proficiency with Robot-Assisted Radical Prostatectomy: Laparoscopic-Trained versus Robotics-Trained Surgeons. Can. Urol. Assoc. J. 2013, 7, E711. [Google Scholar] [CrossRef]
- Mottrie, A.; De Naeyer, G.; Schatteman, P.; Carpentier, P.; Sangalli, M.; Ficarra, V. Impact of the Learning Curve on Perioperative Outcomes in Patients Who Underwent Robotic Partial Nephrectomy for Parenchymal Renal Tumours. Eur. Urol. 2010, 58, 127–133. [Google Scholar] [CrossRef]
Variable | Cohort (n = 27) |
---|---|
Age (n, median, IQR) | 68 (57–73) |
Gender (n, %)
|
|
BMI (kg/m2, median, IQR) | 27.4 (25.9–31.2) |
ASA score (n, %)
|
|
Charlson Comorbidity Index (median, IQR) | 4 (3–5) |
Diabetes (n, %) | 2 (7.4%) |
Hypertension (n, %) | 14 (51.8%) |
Preoperative Hemoglobin (g/dL, median, IQR) | 14.7 (12.3–15.4) |
Preoperative Creatinine (mg/dL, median, IQR) | 0.93 (0.81–1.09) |
Preoperative eGFR (mL/min/1.73 m2, median, IQR) | 77.5 (64.2–92.3) |
Clinical Tumor Size (mm, median, IQR) | 34 (26–45) |
cT (n, %)
|
|
Side (n, %)
|
|
R.E.N.A.L. score (median, IQR) | 7 (5–8) |
Variable | Cohort (n = 27) |
---|---|
Operative Time (min, median, IQR) | 91 (50–149) |
Estimated blood loss (ml, median, IQR) | 150 (50–450) |
Clavien–Dindo complications (n,%)
|
|
Length of Stay (days, median, IQR) | 3 (3–4) |
Hemoglobin at discharge (g/dL, median, IQR) | 11.2 (9.1–12.3) |
Creatinine at discharge (mg/dL, median, IQR) | 0.93 (0.82–1.13) |
eGFR at discharge (mL/min/1.73 m2, median, IQR) | 74.9 (63–92.1) |
Readmission (n, %) | 0 (0%) |
Pathological Size (mm, median, IQR) | 30 (20–43) |
Pathology (n, %)
|
|
Histology subtype (n, %)
|
|
Positive Margins (n, %) | 1 (3.7%) |
pT Stage (n, %)
|
|
Creatinine at last follow-up (mg/dL, median, IQR) | 0.99 (0.85–1-14) |
eGFR at last follow-up (mL/min/1.73 m2, median, IQR) | 79.3 (58.3–87.8) |
Trifecta achievement rate (n, %) | 20 (74.1%) |
Proficiency Score (n, %) | 20 (74.1%) |
Variable | Univariate Analysis | Multivariate Analysis | ||||||
---|---|---|---|---|---|---|---|---|
Odds Ratio | 95.0% CI | Odds Ratio | 95.0% CI | |||||
Inferior | Superior | p-Value | Inferior | Superior | p-Value | |||
Age | 1.03 | 0.96 | 1.10 | 0.37 | - | - | - | - |
Gender | 0.61 | 0.08 | 4.37 | 0.62 | - | - | - | - |
BMI | 0.89 | 0.73 | 1.08 | 0.24 | - | - | - | - |
ASA score | 0.33 | 0.07 | 1.55 | 0.16 | - | - | - | - |
Side | 0.58 | 0.19 | 1.76 | 0.34 | - | - | - | - |
Diabetes | 1.05 | 0.66 | 1.68 | 0.81 | - | - | - | - |
Hypertension | 0.16 | 0.03 | 0.82 | 0.02 | 0.11 | 0.01 | 2.07 | 0.14 |
Preoperative Hb | 0.66 | 0.38 | 1.16 | 0.15 | - | - | - | - |
Preoperative eGFR | 0.98 | 0.92 | 1.02 | 0.53 | - | - | - | - |
R.E.N.A.L. score | 0.71 | 0.56 | 0.99 | 0.09 | - | - | - | - |
Clinical tumor size | 0.96 | 0.92 | 1.01 | 0.13 | - | - | - | - |
Docking time | 1.1 | 0.90 | 1.35 | 0.32 | - | - | - | - |
Estimated Blood Loss | 0.99 | 0.98 | 1.00 | 0.11 | - | - | - | - |
Length of stay | 0.62 | 0.08 | 11.2 | 0.95 | - | - | - | - |
Pathological tumor size | 0.92 | 0.89 | 0.99 | 0.04 | 0.91 | 0.82 | 1.01 | 0.09 |
Number of consecutive procedures (>12 vs. <12) | 13.7 | 2.05 | 21.1 | 0.007 | 8.1 | 1.44 | 14.6 | 0.03 |
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Prata, F.; Basile, S.; Tedesco, F.; Ragusa, A.; Pira, M.; Iannuzzi, A.; Fantozzi, M.; Civitella, A.; Scarpa, R.M.; Papalia, R. Skill Transfer from Laparoscopic Partial Nephrectomy to the Hugo™ RAS System: A Novel Proficiency Score to Assess Surgical Quality during the Learning Curve. J. Clin. Med. 2024, 13, 2226. https://doi.org/10.3390/jcm13082226
Prata F, Basile S, Tedesco F, Ragusa A, Pira M, Iannuzzi A, Fantozzi M, Civitella A, Scarpa RM, Papalia R. Skill Transfer from Laparoscopic Partial Nephrectomy to the Hugo™ RAS System: A Novel Proficiency Score to Assess Surgical Quality during the Learning Curve. Journal of Clinical Medicine. 2024; 13(8):2226. https://doi.org/10.3390/jcm13082226
Chicago/Turabian StylePrata, Francesco, Salvatore Basile, Francesco Tedesco, Alberto Ragusa, Matteo Pira, Andrea Iannuzzi, Marco Fantozzi, Angelo Civitella, Roberto Mario Scarpa, and Rocco Papalia. 2024. "Skill Transfer from Laparoscopic Partial Nephrectomy to the Hugo™ RAS System: A Novel Proficiency Score to Assess Surgical Quality during the Learning Curve" Journal of Clinical Medicine 13, no. 8: 2226. https://doi.org/10.3390/jcm13082226