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

Autor: Azawi NH; Department of Urology, Roskilde Hospital , Roskilde , Denmark., Norus TP, Wittendorff HE, Dahl C
Jazyk: angličtina
Zdroj: Scandinavian journal of urology [Scand J Urol] 2014 Dec; Vol. 48 (6), pp. 538-43. Date of Electronic Publication: 2014 Jun 16.
DOI: 10.3109/21681805.2014.925499
Abstrakt: 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.
Databáze: MEDLINE
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