A novel assessment model for teaching robot-assisted living donor nephrectomy in abdominal transplant surgery fellowship

Background: An increasing number of transplant centers have adopted robot-assisted living donor nephrectomy. Thus, a transplant fellow assessment tool is needed for promoting operative independence in an objective and safe manner. Methods: In this pilot study, data was prospectively collected on both fellow performance with focus on technique, efficiency, and communication (“overall RO-SCORE”), and operative steps (“operative steps RO-SCORE”). Robotic user performance metrics were analyzed from the da Vinci Xi system, including fellow percent active control time (ACT) and handoff counts. Results: From July 2020 to February 2021, twenty-one robot-assisted donor nephrectomies were performed. In regression analysis, fellow performance (based on both RO-SCOREs and robot % ACT) was significantly associated with both time and case number, with time-to-independence modelled at 8.4–14.2 months, and case number-to-independence estimated at 15–22 cases. Robot user metrics provided valid objective measures alongside RO-SCOREs. Conclusions: This pilot study provides an effective assessment tool for promoting operative competency in robot-assisted donor nephrectomy among transplant fellows.