title: Integrating robotic partial nephrectomy to an existing robotic surgery program.
abstract: BACKGROUND
  As more centers develop robotic proficiency, progressing to a successful robot-assisted partial nephrectomy (RAPN) program depends on a number of factors.  We describe our technique, results, and analysis of program setup for RAPN.
  
  
  METHODS
  Between 2005 and 2011, 92 RAPNs were performed following maturation of a robotic prostatectomy program.  Operating rooms and supply rooms were outfitted for efficient robotic throughput.  Tilepro and intraoperative ultrasound were used for all cases.  Training and experiential learning for surgeons, anesthesia and nursing staff was a high priority.  An onsite robotic technician helped troubleshoot, prepare the room and staff prior to starting surgery, and provide assistance with different robotic models.
  
  
  RESULTS
  Average operative time decreased over time from 235 min to 199 min (p = .03).  Warm ischemia time decreased from 26 minutes to 23 minutes (p = .02) despite an increased complexity of tumors and operations on multiple tumors.  Median estimated blood loss was 150 mL.  Average length of hospital stay was 3 days (range 1-9).  Average size of lesions was 2.7 cm (range 0.7-8.6).  Final pathology demonstrated 71 (77%) malignant lesions and 21 (23%) benign lesions.
  
  
  CONCLUSIONS
  The addition of a robot-assisted partial nephrectomy program to an institutional robotic program can be coordinated with several key steps.  Outcomes from an operational, oncologic, and renal functional standpoint are acceptable.  Despite increased complexity of tumors and treatment of multiple lesions, operative and warm ischemia times showed a decrease over time.  An organizational model that involves the surgeons, anesthesia, nursing staff, and possibly a robotic technical specialist helps to overcome the learning curve.
authors.affiliation: City of Hope National Cancer Center., Duarte, California 91010, USA.
authors.forename: Bertram
authors.initials: B
authors.lastname: Yuh
authors.forename: Shantel
authors.initials: S
authors.lastname: Muldrew
authors.forename: Anita
authors.initials: A
authors.lastname: Menchaca
authors.forename: Wesley
authors.initials: W
authors.lastname: Yip
authors.forename: Clayton
authors.initials: C
authors.lastname: Lau
authors.forename: Timothy
authors.initials: T
authors.lastname: Wilson
authors.forename: David
authors.initials: D
authors.lastname: Josephson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D001810:Blood Volume; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000193:education / Q000295:instrumentation / Q000379:methods*; D059032:Learning Curve; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000193:education / Q000295:instrumentation / Q000379:methods*; D012371:Robotics / Q000193:education / Q000379:methods*; D013997:Time Factors; D052096:Warm Ischemia