Abstract：Objective: To analyze the operator’s learning curve for robot-assisted kidney transplantation, and report the surgical techniques and optimized technique of regional hypothermia of donor kidney. Methods: Totally, 18 patientswith end-stage renal disease undergoing robot-assisted kidney transplantation at the Chinese PLA General Hospital between March 2018 and September 2021 were included. All of surgeries were performed by the same surgical team with rich experience in the field of open kidney transplantation and robot-assisted surgery. The Cumulative sum analysis and Shewhart control charts were used to evaluate the operator’s learning curve, technical quality control and patients’ safety. Results: The cumulative sum analysis showed that there wasa significantly initial learning stage in robotic-operation time, re-warming time, arterialanastomosis time,venous anastomosis time, all these fouritemsentered the platform stage when the number of cases reached 10. It was suggested that at least 10 cases were needed in the learning stage of the four items, and then the corresponding stable abilities could be obtained. The further Shewhart control charts showed that the robotic-operation time and venous anastomosis time did not exceed the warning line and alarm line, suggesting that the results of the above two techniques were stable and were not affected by the individual or systemicfactors during the operation. Meanwhile, 94.4% of the rewarming time was shorter than the warning line, 83.3% of the arterial anastomosis time was shorter than the warning line, but none of these two technical items exceeded the alarm line, suggesting that although in the initial cases, the rewarming time and arterial anastomosis time in some cases were out of control, the overall improvement and stable shortening could be obtained. The difference between eGFR before operation and at 6th month after operation was 67.69mL/min, indicating that the kidney functioned well.Conclusion: An experienced surgical team needs at least 10 cases of experience to achieve stable repeatability in terms of robotic-operation time, rewarming time and arterial/venous anastomosis.
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