The Effects of Simultaneously Training Additional Surgeons in the Living Donor Robotic Assisted Kidney Transplant

Purpose: Minimally invasive surgery is an ever-developing field in surgery. Numerous international transplant programs have reported the success and safety of robotic assisted kidney transplant surgery. The first robotic assisted kidney transplant (RAKT) at Henry Ford was performed on May 13, 2014. In August 2018, the lead surgeon started training an additional senior staff surgeon at Henry Ford in addition to a junior transplant surgery fellow. Studies have shown that the learning curve for RAKT is short, but the details regarding a training program in the US has not been reported. This study hopes to validate the safety of simultaneously training multiple surgeons in the RAKT. Methods: 50 living donor RAKT were performed between January 2014 and November 2018. 3 recipients were converted to open and were thus excluded from this study. The number of surgeons involved with each transplant was used to stratify the surgeries. Single surgeon operations were compared to two and surgeon operations where there was either one or two trainees participating respectively Total operative time and post operative creatinine trends were analyzed. Results: 47 living donor robotic assisted kidney transplants were evaluated. One surgeon cases totaled 11. Two surgeon cases totaled 14. Three surgeon cases totaled 7. Cold ischemia time and warm ischemia time did not differ between one surgeon. two surgeon and three surgeon cases (7. 8, 94. 6, 87. 1 and 46. 8, 48. 9, 45. 7 respectively; p= 0. 48 and 0. 81). Serum creatinine levels were measured at days 3, 7, 14, 6 months and 1 year. Serum creatinine levels were no different when comparing one surgeon, two surgeon and three surgeon cases. EBL and operative times were also no different (p = 0. 76 and 0. 87 respectively). Conclusions: In order to gain adequate experience with robotic assisted minimally invasive surgery, and in attempt to utilize safe technology, training multiples surgeons does not appear to affect operative times or post operative creatinine levels. Simultaneous training of multiple surgeons on the Da Vinci robotic console appears to be a safe way of training surgeons in RAKT