Hand-assisted partial nephrectomy with early arterial clamp removal: Impact of the learning curve. (December 2014)

• Record Type: Journal Article
• Authors: Azawi, Nessn H.; Norus, Thomas P.; Wittendorff, Hans-Erik; Dahl, Claus
• Is Part Of: Scandinavian journal of urology. Volume 48:Number 6(2014)
• Page Start: 538
• Page End: 543
• Publication Date: 2014-12
• Subjects: Urology -- Periodicals; 616.6
• DOI: 10.3109/21681805.2014.925499
• Languages: English
• ISSNs: 2168-1805

Abstract

<abstract> <title>Abstract</title> <p> <italic>Objective.</italic> The aims of this study were to present the results of hand-assisted laparoscopic partial nephrectomy according to the margin, ischaemia and complications system; to assess the role of the learning curve; and to compare this approach with other approaches. <italic>Material and methods.</italic> Data from 60 consecutive patients were obtained from a prospectively maintained database. The patients were divided into three cohorts (1, 2 and 3), with 20 patients each, according to their surgery dates. <italic>Results.</italic> The overall margin, ischaemia and complications rate was 90%. The warm ischaemia time was 9.5 min in cohort 1, decreasing to 5 min in cohort 3 (<italic>p</italic> < 0.0001). The Padua score (<italic>p</italic> = 0.0287) and tumour size (<italic>p</italic> = 0.0003) were significantly increased in cohort 3, but loss of kidney function decreased significantly to 3.5% in this cohort. Loss of kidney function of less than 5% was reported for eight (40%), nine (45%) and 14 (70%) patients in cohorts 1, 2 and 3, respectively (<italic>p</italic> = 0.0185). <italic>Conclusions.</italic> Hand-assisted laparoscopic partial nephrectomy with early removal of arterial clamps is safe and easy to learn. An expert laparoscopic surgeon can perform hand-assisted laparoscopic partial nephrectomy for complex tumours with a relatively high success rate according to the margin, ischaemia and complications system. Warm ischaemia time could be obtained within 5 min after 40 procedures.</p> </abstract>