V7-06: Recipient Robot Assisted Kidney Transplant Learning steps: Frame-by-Frame Video Analysis

Video

Introductions and Objectives
Transplant surgeons learning robot-assisted kidney transplant (RAKT) should master skills specific to robotic vascular anastomoses in the dry and wet laboratory before proctoring on a patient. We compared the video recordings of the vascular anastomoses done by two groups of RAKT-performing transplant surgeons: one with extensive robotic experience, and other with minimal robotic orientation. We aimed to identify specific domains that require training to ensure safe and efficient performance of RAKT.

Methods
41 patients undergoing recipient RAKT were classified into two groups based on the transplant surgeon’s robotic experience: Group 1 (n=27) with extensive robotic experience (>2000 cases), and Group 2 (n=14) with minimal robotic orientation (2000 cases for each). Measures of surgical process and functional patient outcomes were recorded for all 41 patients. Experienced robotic and transplant surgeons proctored all the operations to minimize compromise in functional patient outcomes. Two independent reviewers retrospectively analyzed the video recordings of venous and arterial anastomoses of 6 cases from each group (3 initial cases and 3 final cases in each group).

Results
The results are summarized in Tables 1 and 2. There was no significant difference in the baseline characteristics of patients in both the groups. Console camera modulation to optimize magnification of the operating field, tissue handling in absence of tactile feedback, and coordination of the robotic needle driver and forceps with the needle and suture were recognized as vital training points for vascular anastomoses.

Conclusions
We found that even experienced open kidney transplant surgeons need extensive training for robotic surgery. The differences in vascular anastomoses techniques of transplant surgeons with vs. without robotic experience, as shown in the video, can be used to mentor trainee surgeons in the laboratory before patient proctoring, thereby ensuring patient safety.

Funding: none