Azawi, Nessn H2; Norus, Thomas P2; Wittendorff, Hans-Erik2; Dahl, Claus3
1 Department of Clinical Medicine, Department of Clinical Medicine, Faculty of Health and Medical Sciences, Københavns Universitet2 unknown3 Department of Clinical Medicine, Department of Clinical Medicine, Faculty of Health and Medical Sciences, Københavns Universitet
Impact of the learning curve
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.
Scandinavian Journal of Urology, 2014, Vol 48, Issue 6, p. 538-543