title: Does teaching of robotic partial nephrectomy affect renal function and perioperative outcomes?
abstract: Partial nephrectomy (PN) represents the treatment of choice for localized renal tumor<7cm. Minimally invasive approaches are considered standard of care in many institutions. Maintaining acceptable warm ischemic time (WIT) while teaching robotic PN (RPN) remains challenging. The goal of the present study was to assess the effect of teaching RPN on WIT and renal function in patients undergoing RPN.
  
  
  
  Patients undergoing RPN for cT1-T2 renal tumors were included. RENAL nephrometry score was used to adjust for tumor complexity. Glomerular filtration rates (GFR) were determined preoperatively, at day 2 and at ≥3-month follow-up. Patients in whom the attending surgeon (staff) performed tumorectomy and renorraphy were compared with those in whom the fellow performed these steps. Primary outcomes were WIT and GFR decrease at follow-up visit. Morbidity and margin positivity represented secondary outcomes.
  
  
  
  Overall, 69 patients (46 "staff" vs. 23 "fellow") were included. Patient׳s characteristics did not differ significantly between the 2 groups. In particular, RENAL score and preoperative GFR were similar between both groups. Mean WIT was 22±9 in the staff and 24±7 in the fellow group (P = 0.09). At follow-up, a GFR reduction of 9% was observed in the staff group vs. 13% in the fellow group (P = 0.38). Complication rates (13% vs. 17%, P = 0.63) and positive margins (9% vs. 4%, P = 0.47) did not differ significantly between staff and fellow.
  
  
  
  In our experience, teaching RPN with a strict supervision and stepwise standardized procedure was oncologically and functionally safe after 3 to 6 months of follow-up.
authors.affiliation: Department of Urology, Jewish General Hospital, McGill University, Montreal, Canada; Department of Urology, McGill University Health Center, Montreal, Canada; Service d׳urologie, Centre hospitalier universitaire vaudois, Lausanne, Switzerland. Electronic address: yannick.cerantola@chuv.ch.
authors.forename: Yannick
authors.initials: Y
authors.lastname: Cerantola
authors.affiliation: Service d׳urologie, Saint Jean Languedoc Hospital, Toulouse, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Ploussard
authors.affiliation: Service d׳urologie, Centre hospitalier universitaire vaudois, Lausanne, Switzerland.
authors.forename: Wassim
authors.initials: W
authors.lastname: Kassouf
authors.affiliation: Department of Urology, Jewish General Hospital, McGill University, Montreal, Canada.
authors.forename: Maurice
authors.initials: M
authors.lastname: Anidjar
authors.affiliation: Department of Urology, Jewish General Hospital, McGill University, Montreal, Canada.
authors.forename: Franck
authors.initials: F
authors.lastname: Bladou
mesh_terms: D000368:Aged; D005257:Fellowships and Scholarships; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D000072662:Margins of Excision; D008505:Medical Staff, Hospital; D008875:Middle Aged; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D009392:Nephrectomy / Q000009:adverse effects / Q000193:education* / Q000379:methods; D061646:Operative Time; D011184:Postoperative Period; D057234:Preoperative Period; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000193:education*; D052096:Warm Ischemia
keywords: Fellow; Partial nephrectomy; Robot; Teaching; Warm ischemia time