title: Transition from laparoscopic to robotic partial nephrectomy: the learning curve for an experienced laparoscopic surgeon.
abstract: BACKGROUND
  The complexity of laparoscopic partial nephrectomy (LPN) has prompted many laparoscopic surgeons to adopt robotic partial nephrectomy (RPN) for the treatment of small renal masses. We assessed the learning curve for an experienced laparoscopic surgeon during the transition  from LPN to RPN.
  
  
  METHODS
  We compared perioperative outcomes of the first 20 patients who underwent RPN to the last 18 patients who underwent LPN by the same surgeon (MAP). Surgical technique was consistent across platforms. The learning curve was defined as the number of cases  required to consistently perform RPN with shorter average operative times (OT) and warm ischemia times (WIT), as compared to the last 18 LPN. A line of best fit aided graphical interpretation of the learning curve on a scatter diagram of OT versus procedure date.
  
  
  RESULTS
  The 2  groups had comparable preoperative demographics and tumor histopathology. No patients in either group had a positive surgical margin. There was a downward trend in both OT and WIT during the RPN learning curve. After the first 5 RPN cases, the average OT reached the average OT of the last  18 LPN cases. The average OT of the first 5 RPN patients was 242.8 minutes, compared with the average OT of the last 15 RPN patients of 171.3 minutes (P=0.011).
  
  
  CONCLUSIONS
  The transition from LPN to RPN is rapid in an experienced laparoscopic surgeon. There were no significant  differences in WIT, estimated blood loss, or length of hospital stay between LPN and RPN. RPN achieved a similar OT as LPN after 5 procedures.
authors: Department of Urology, The Mount Sinai Medical Center, New York, New York, USA.
authors: Hugh J
authors: HJ
authors: Lavery
authors: Alexander C
authors: AC
authors: Small
authors: David B
authors: DB
authors: Samadi
authors: Michael A
authors: MA
authors: Palese
mesh_terms: D000328:Adult; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies; D012371:Robotics