title: Impact of assistant surgeon on outcomes in robotic surgery.
abstract: BACKGROUND
  It is believed that the outcomes of robotic surgery depends not only on the experience of the console surgeon but also the patient-side assistant. However, objective data supporting it is lacking. The aim of this study was to objectively determine change in operative outcomes with increasing experience of patient-side assistant.
  
  
  METHODS
  We performed a retrospective analysis of 222 urologic robotic procedures performed by two teams of surgeon-assistant and split the data into two chronological halves according to date of surgery. We considered that the assistant was inexperienced in the 1(st) half and had become experienced by the 2(nd) half, and we compared mean operative time and blood loss between these two halves of his experience.
  
  
  RESULTS
  We observed that with increasing experience of the assistant, the mean operative time reduced from 138.06 to 124.32 min (P = 0.001) and mean blood loss decreased from 191.93 to 187.61 ml (P = 0.57). On subset analysis, a consistent trend of reduction in the mean operative time was noted for both the assistants separately and for all surgical procedures included in the analysis. Maximum reduction was noted for pyeloplasty which was the most commonly performed surgery. The mean blood loss had a varied relation to the experience of the assistant and did not reach statistical significance in either direction.
  
  
  CONCLUSIONS
  With increasing experience of the patient-side surgeon, the mean operative time for all robotic procedures showed a consistent trend of reduction across all types of surgery with greater reduction for commonly performed procedures.
authors.affiliation: Department of Urology, All Institute of Medical Sciences, New Delhi, India.
authors.forename: Rishi
authors.initials: R
authors.lastname: Nayyar
authors.affiliation: Department of Urology, All Institute of Medical Sciences, New Delhi, India.
authors.forename: Siddharth
authors.initials: S
authors.lastname: Yadav
authors.affiliation: Department of Urology, All Institute of Medical Sciences, New Delhi, India.
authors.forename: Prabhjot
authors.initials: P
authors.lastname: Singh
authors.affiliation: Department of Urology, All Institute of Medical Sciences, New Delhi, India.
authors.forename: Prem Nath
authors.initials: PN
authors.lastname: Dogra
keywords: Outcomes of robotic surgery; robotic surgery; scrubbed surgeon; surgical robot