title: [Perioperative Outcomes in Correlation to the Learning Curve for Robotic Assisted Partial Nephrectomy: The First 109 Cases of our Clinic].
abstract: BACKGROUND
  In contrast to conventional laparoscopic partial nephrectomy, the approach of robot-assisted partial nephrectomy (RAPN) shows a steep learning curve with shorter warm ischaemia times (WIT) and comparable postoperative outcomes. Therefore RAPN is considered a good minimally-invasive surgical procedure for patients presenting with a renal cell carcinoma in clinical stage cT1a. The aim of the presented study was to evaluate the perioperative outcomes of our patients after RAPN and to illustrate the learning curve based on characteristic perioperative parameters such as WIT.
  
  
  METHODS
  The data of 109 patients treated by RAPN in our clinic between January 2010 and April 2015 were retrospectively analysed regarding perioperative, laboratory and oncological outcomes. Postoperative complications until 30 days after surgery were documented. We analysed the data of the largest patient population treated by a single urologist, comparing WIT, operating time, blood loss and decline of the glomerular filtration rate between the first and the second 30 consecutive cases.
  
  
  RESULTS
  Mean WIT was 18.4 min (SD±10.2), mean operating time was 199 min (SD±20), and mean estimated blood loss was 657 millilitres (SD±715 ml). Mean loss of GFR was reported to be 4.99 mg/dl/1.73 m (2) (SD±15.44). 83 (76%) malignant lesions were removed. 11 patients (10%) had a R1 resection, one patient had a R2 resection and in 2 cases the resection status was Rx. 22% of patients developed postoperative complications. Intraoperative complications were documented in 2 cases. According to the Clavien-Dindo Classification, 6% of patients had grade 1 and 2 complications and 13% developed grade 3 and 4 complications. WIT was significantly lower after 30 consecutive cases treated by one urologist. Regarding operating time, GFR or blood loss no significant correlation was found.
  
  
  CONCLUSIONS
  Our data is in line with the surgical outcomes described in the literature. RAPN is a safe surgical technique with a steep learning curve. In our experience, 30 surgical cases provide a urologist with sufficient expertise to achieve good perioperative results. Weaknesses of this report include the retrospective design and insufficient documentation in some cases.
authors.affiliation: Urologische Klinik und Poliklinik der Universitätsmedizin der Johannes Gutenberg Universität Mainz.
authors.forename: J
authors.initials: J
authors.lastname: Cordier
authors.affiliation: Urologische Klinik und Poliklinik der Universitätsmedizin der Johannes Gutenberg Universität Mainz.
authors.forename: A
authors.initials: A
authors.lastname: Neisius
authors.affiliation: Urologische Klinik und Poliklinik der Universitätsmedizin der Johannes Gutenberg Universität Mainz.
authors.forename: C
authors.initials: C
authors.lastname: Thomas
authors.affiliation: Urologische Klinik und Poliklinik der Universitätsmedizin der Johannes Gutenberg Universität Mainz.
authors.forename: C
authors.initials: C
authors.lastname: Hampel
authors.affiliation: Urologische Klinik und Poliklinik der Universitätsmedizin der Johannes Gutenberg Universität Mainz.
authors.forename: J W
authors.initials: JW
authors.lastname: Thüroff
authors.forename: W
authors.initials: W
authors.lastname: Brenner
authors.affiliation: Urologische Klinik und Poliklinik der Universitätsmedizin der Johannes Gutenberg Universität Mainz.
authors.forename: F C
authors.initials: FC
authors.lastname: Roos
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology*; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000193:education* / Q000379:methods*; D061646:Operative Time; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000193:education* / Q000379:methods*; D013223:Statistics as Topic; D052096:Warm Ischemia