title: Robotic partial nephrectomy shortens warm ischemia time, reducing suturing time kinetics even for an experienced laparoscopic surgeon: a comparative analysis.
abstract: OBJECTIVE
  Laparoscopic and robotic partial nephrectomy (LPN and RPN) are strongly related to influence of tumor complexity and learning curve. We analyzed a consecutive experience between RPN and LPN to discern if warm ischemia time (WIT) is in fact improved while accounting for these two confounding variables and if so by which particular aspect of WIT.
  
  
  METHODS
  This is a retrospective analysis of consecutive procedures performed by a single surgeon between 2002-2008 (LPN) and 2008-2012 (RPN). Specifically, individual steps, including tumor excision, suturing of intrarenal defect, and parenchyma, were recorded at the time of surgery. Multivariate and univariate analyzes were used to evaluate influence of learning curve, tumor complexity, and time kinetics of individual steps during WIT, to determine their influence in WIT. Additionally, we considered the effect of RPN on the learning curve.
  
  
  RESULTS
  A total of 146 LPNs and 137 RPNs were included. Considering renal function, WIT, suturing time, renorrhaphy time were found statistically significant differences in favor of RPN (p < 0.05). In the univariate analysis, surgical procedure, learning curve, clinical tumor size, and RENAL nephrometry score were statistically significant predictors for WIT (p < 0.05). RPN decreased the WIT on average by approximately 7 min compared to LPN even when adjusting for learning curve, tumor complexity, and both together (p < 0.001).
  
  
  CONCLUSIONS
  We found RPN was associated with a shorter WIT when controlling for influence of the learning curve and tumor complexity. The time required for tumor excision was not shortened but the time required for suturing steps was significantly shortened.
authors.affiliation: Department of Urology, Unit 1373, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA.
authors.forename: Eliney F
authors.initials: EF
authors.lastname: Faria
authors.forename: Peter A
authors.initials: PA
authors.lastname: Caputo
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Wood
authors.forename: Jose A
authors.initials: JA
authors.lastname: Karam
authors.forename: Graciela M
authors.initials: GM
authors.lastname: Nogueras-González
authors.forename: Surena F
authors.initials: SF
authors.lastname: Matin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000601:surgery; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009392:Nephrectomy / Q000379:methods*; D061646:Operative Time; D011361:Professional Competence; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods*; D013537:Sutures; D016896:Treatment Outcome; D052096:Warm Ischemia / Q000706:statistics & numerical data*