title: The role of the assistant during robot-assisted partial nephrectomy: does experience matter?
abstract: The objective of this study was to evaluate surgical outcomes with respect to the experience level of the bedside assistant during robot-assisted partial nephrectomy. A retrospective review was conducted of a prospectively maintained database of 414 consecutive robot-assisted laparoscopic partial nephrectomies performed by experienced robotic surgeons at our institution from April 2011 to September 2014. A senior-level assistant was defined as a resident in his or her post-graduate year (PGY) 4 or 5, or a fellow. Junior-level assistants were considered to be PGY-2, PGY-3, or a nurse first assistant. Multivariate analyses were performed using linear, Poisson, and logistic regression models. There were 115 junior-level cases and 299 senior-level cases. On univariate analysis, the experience level of the assistant had no impact on operative time (168 for junior level vs. 163 min for senior level, p = 0.656). Likewise, there were no differences between the junior- and senior-level groups with regard to warm ischemia time (21.3 vs. 20.9 min, p = 0.843), negative margin status (111/115 (96.5 %) vs. 280/299 (93.6 %), p = 0.340), or postoperative complications (17/115 (14.8 %) vs. 35/299 (11.7 %), p = 0.408). After multivariate analysis, operative time was associated with increased body mass index and tumor size (both p < 0.001), but not with resident experience level (p = 0.051). Estimated blood loss and postoperative complications were also not associated with the PGY of the assistant (p = 0.488 and p = 0.916, respectively). Despite common concern, the PGY status of a physician trainee serving as the bedside assistant does not appear to influence the outcomes of robot-assisted partial nephrectomy at a high-volume center.
authors.affiliation: Division of Urologic Surgery, Washington University School of Medicine, 4960 Children's Place, Campus Box 8242, St. Louis, MO, 63110, USA. potretzkea@wudosis.wustl.edu.
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Potretzke
authors.affiliation: Division of Urologic Surgery, Washington University School of Medicine, 4960 Children's Place, Campus Box 8242, St. Louis, MO, 63110, USA.
authors.forename: Brent A
authors.initials: BA
authors.lastname: Knight
authors.affiliation: Division of Urologic Surgery, Washington University School of Medicine, 4960 Children's Place, Campus Box 8242, St. Louis, MO, 63110, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Brockman
authors.affiliation: Division of Urologic Surgery, Washington University School of Medicine, 4960 Children's Place, Campus Box 8242, St. Louis, MO, 63110, USA.
authors.forename: Joel
authors.initials: J
authors.lastname: Vetter
authors.affiliation: Division of Urologic Surgery, Washington University School of Medicine, 4960 Children's Place, Campus Box 8242, St. Louis, MO, 63110, USA.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Figenshau
authors.affiliation: Division of Urologic Surgery, Washington University School of Medicine, 4960 Children's Place, Campus Box 8242, St. Louis, MO, 63110, USA.
authors.forename: Sam B
authors.initials: SB
authors.lastname: Bhayani
authors.affiliation: Urology Academic Practice, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Benway
mesh_terms: D016063:Blood Loss, Surgical; D002983:Clinical Competence / Q000592:standards; D004503:Education, Medical, Graduate / Q000592:standards; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000592:standards; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D010823:Physician Assistants / Q000592:standards*; D010819:Physician's Role; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome; D052096:Warm Ischemia
keywords: Neoplasm; Nephrectomy; Partial nephrectomy; Postoperative complications; Robotics