The impact of a fellow on a regional robotic-assisted partial nephrectomy service.

Introduction: Training a fellow has a cost in time and effort for the surgeon and their team. Their relative inexperience may also negatively affect the patient. The aim of this study was to determine and quantify the impact of a fellow on a regional robotic-assisted partial nephrectomy service and on perioperative outcomes.

Materials And Methods: We reviewed the prospectively collected data for 522 patients who had undergone robotic-assisted partial nephrectomy since 2015 during the tenure of six fellows. Perioperative outcomes for three groups were compared: group A (no fellow participation), group B (some participation) and group C (fellow completed entire operation). We also reviewed progression over 12 months.

Results: Demographics were similar in all groups apart from the percentage of men, which was lower in group C (< 0.05). Operative time was 27 minutes longer for group B (< 0.001). Warm ischaemia time was significantly shorter for group A but the difference was only four minutes (< 0.001). Length of stay was slightly shorter for group C compared with the other groups (< 0.01). Trifecta achievement was greatest for group A (< 0.001). There were no perioperative deaths in any group and positive margins, complications and readmissions were low and similar in all groups. Towards the end of their fellowship, fellows performed more operations independently.

Conclusion: There is a measurable, but small, negative impact of a fellow on a robotic-assisted partial nephrectomy service, which reduces with experience. With appropriate supervision and patient selection, a fellow can be taught robotic-assisted partial nephrectomy without affecting patient safety or treatment outcome.