Journal of endourology | 2021
Establishing a robot assisted kidney transplant program - Independent evaluation of the learning curve and surgical nuances.
Abstract
Background Robot assisted kidney transplantation is a technically challenging procedure and there has been limited reporting of its learning curve, mostly by a single surgical working group. The aim of the current study was to perform an independent analysis of learning curve and describe our modifications in technique of robot assisted kidney transplant. Materials and methods All consecutive cases performed at our center from April 2016 till March 2020 were reviewed. Learning curve was analyzed using cumulative summation method for total anastomosis time (technical outcome) and serum creatinine at day seven and 30 (functional outcome). Patient safety was assessed using Shewhart control charts and comparison of safety outcomes before and after achieving learning curve was done using Chi square or Fischer exact test as appropriate. Descriptive review of technical modifications made during our experience was given. Results Ninety patients underwent robot assisted renal transplant during study period. Learning curve was crossed at 24 cases (total anastomosis time) and 15-25 cases (serum creatinine). Shewhart control charts showed that total anastomosis time remained below alert/alarm line in 94.4%/98.9% cases with alert line being crossed significantly greater number of times before the learning curve. Serum creatinine values remained below alert/alarm line in 85.5%/90% cases at day seven and 92.2%/96.7% cases at day 30 with no difference made due to learning curve. Key technical modifications included arterial and ureteric spatulation at bench, use of polypropylene 5-0 holding stitch in graft vessels to facilitate intra-operative handling, keeping anterior arterial wall smaller to visualize posterior arterial wall anastomosis and leaving small amount of fatty tissue on supero-lateral surface of kidney for handling after jacket removal. Conclusion Our learning curve of robot assisted kidney transplant was crossed at 24 cases (technical outcome) and 15-25 cases (functional outcome). We have also detailed valuable technical modifications in the procedure.