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Hand-assisted partial nephrectomy with early arterial clamp removal: Impact of the learning curve: Impact of the learning curve

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningfagfællebedømt

  • Nessn H Azawi
  • Thomas P Norus
  • Hans-Erik Wittendorff
  • Claus Dahl

OBJECTIVE: 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.

MATERIAL AND METHODS: 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.

RESULTS: 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 (p < 0.0001). The Padua score (p = 0.0287) and tumour size (p = 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 (p = 0.0185).

CONCLUSIONS: 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.

OriginalsprogEngelsk
TidsskriftScandinavian Journal of Urology
Vol/bind48
Udgave nummer6
Sider (fra-til)538-543
Antal sider6
ISSN0036-5599
DOI
StatusUdgivet - dec. 2014

ID: 135453462