title: Hand-assisted partial nephrectomy with early arterial clamp removal: Impact of the learning curve.
abstract: 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.
  
  
  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.
authors.affiliation: Department of Urology, Roskilde Hospital , Roskilde , Denmark.
authors.forename: Nessn H
authors.initials: NH
authors.lastname: Azawi
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Norus
authors.forename: Hans-Erik
authors.initials: HE
authors.lastname: Wittendorff
authors.forename: Claus
authors.initials: C
authors.lastname: Dahl
mesh_terms: D000368:Aged; D005260:Female; D005919:Glomerular Filtration Rate; D058733:Hand-Assisted Laparoscopy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D007680:Kidney Neoplasms / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D047368:Tumor Burden; D052096:Warm Ischemia / Q000009:adverse effects
keywords: early arterial clamp removal; hospital stay; learning curve; partial nephrectomy; warm ischaemia time