Incorporation of hand-assisted laparoscopic nephrectomy into an academic training program: an assessment of the utility of a 3-month minifellowship.
BACKGROUND
The aim of this study was to assess the amount of training necessary for a midcareer urologic surgeon to incorporate hand-assisted laparoscopic (HAL) renal surgery into an academic practice.


METHODS
A urologist (JAB) without laparoscopic surgical experience in his fifth year of practice completed a 3-month minifellowship at a high-volume center primarily to learn HAL nephrectomy (HALN), during which he performed 15 HALNs (and 2 HAL nephroureterectomies) and assisted during 5 HALNs. Surgical outcomes and resident surgical participation on nephrectomy cases at the home medical center during the 6 months prior to (phase 1) and after (phase 2) the fellowship were evaluated.


RESULTS
During phase 1, 12 open nephrectomies were performed in a mean operative time of 265 (10-387) minutes. During phase 2, 16 HALNs were initiated and 2 (13%) combined cases were converted to open at the discretion of general surgeon. The mean operative time was 288 (226-355) minutes. Ten (10) and 5 patients from each cohort had concomitant procedures performed. The mean tumor size was 8.7 (2-15) and 7.1 (2.5-15) cm. Three (3) patients from each cohort were anemic preoperatively (hemoglobin < or =10 mg/dL). Ten (10) (83%) and 4 (25%) patients from each cohort received transfusions. There were 3 and 2 intraoperative and postoperative cohort complications, respectively. Residents were the operative surgeon on all cohort 1 and two thirds of cohort 2 cases. Chief residents completed the entirety of their third and fourth HALNs, respectively.


CONCLUSIONS
A 3-month fellowship is an effective tool for a midcareer urologist to rapidly gain significant HALN experience. Twenty-two (22) cases (17 as surgeon) allowed for the immediate incorporation of this procedure into a complex academic practice without any interruption of residency training.
Brown
James A
JA
Division of Urology, Medical College of Georgia, Augusta, Georgia 30912, USA. jimbrown@mcg.edu
Shah
Sagar
S
Siddiqi
Kashif
K
Boyd
Buffi
B
D000328:Adult; D000368:Aged; D005257:Fellowships and Scholarships; D013502:General Surgery / Q000193:education*; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D009392:Nephrectomy / Q000193:education* / Q000379:methods; D012189:Retrospective Studies; D014572:Urology / Q000193:education*