Robot-assisted partial nephrectomy (RAPN) outcomes might be importantly affected by
increasing surgical experience (EXP). The aim of the study is to investigate the effect
of EXP on warm ischemia time (WIT), presence of at least one Clavien-Dindo ≥2 postoperative
complication (CD ≥ 2), and positive surgical margins (PSMs) to define the learning
curve for RAPN. We evaluated 457 consecutive patients diagnosed with a cT1-T2 renal
mass were evaluated. EXP was defined as the total number of RAPNs performed by each
surgeon before each patient's operation. Median WIT was 14min and the rate of CD ≥
2 and PSMs was 15% and 4%, respectively. At multivariable regression analyses adjusted
for case mix, EXP resulted associated with shorter WIT (p<0.0001) and higher probability
of CD ≥ 2-free postoperative course (p=0.001), but not with PSMs (p=0.7). The relationship
between EXP and WIT emerged as nonlinear, with a steep slope reduction within the
first 100 cases and a plateau observed after 150 cases. Conversely, the relationship
between EXP and CD ≥ 2-free course resulted linear, without reaching a plateau, even
after 300 cases. Patient summary: Perioperative outcomes after robot-assisted partial
nephrectomy (RAPN) are importantly and individually affected by surgeon's experience.
After 150 RAPNs, no further improvement is observed with respect to ischemia time,
but the learning curve appears endless with respect to complications.