Endoscopic robot-assisted simple enucleation of renal tumours: Impact of learning curve and tumour complexity on trifecta outcomes

Background In this article, we report the outcomes of endoscopic robot-assisted tumour enucleation (ERASE) using a trifecta system. Methods One hundred eighty-two patients were treated with ERASE by a single surgeon between October 2014 and February 2017 and were stratified by quartiles of distribution called ERASE eras 1 to 4 and preoperative aspects and dimensions used for an anatomical (PADUA) score risk group categories. The trifecta achievement rates in different ERASE eras and PADUA score risk group categories were analysed. Results The overall trifecta achievement rate was 76.4%; this rate progressively increased along the learning curve and reached 87.2% in ERASE era 4 (0.002). PADUA score risk group categories were inversely correlated with the trifecta achievement rate (P < .001). When both variables were simultaneously considered, a trend towards a higher trifecta achievement rate was observed in the recent series regardless of tumour anatomical complexity. Conclusions The trifecta achievement rate increased with surgical experience and was inversely correlated with tumour complexity.