title: Outcomes of open partial nephrectomies performed by Australian trainees.
abstract: BACKGROUND
  Partial nephrectomy (PN) has become the standard of care for small renal tumours, with open partial nephrectomy (OPN) being superseded by minimally invasive PN. Advances in minimal access surgery have resulted in fewer relative contraindications, with subsequently fewer OPN being performed. Consequentially, trainees have less opportunity to gain skills and experience in open renal surgery. The aims of this study were to assess the standard of OPN performed by Australian urological trainees and to define whether OPN is a safe and suitable training opportunity.
  
  
  METHODS
  A retrospective review was undertaken on patients who underwent OPN performed by urology trainees from 2010 to 2014 at two training hospitals in Western Australia. Data collected included patient demographics, surgical and oncological outcomes and morbidity.
  
  
  RESULTS
  Sixty patients underwent OPN, with a mean age of 56 years. Most tumours were single, with mean size 31 mm. Mean operative time was 157 min, with a mean cold ischaemic time of 27 min. Mean pre- and post-operative creatinine levels were equivalent (77 μmol/L). The overall complication rate was 18%, with no documented urinary leaks, and 1.7% blood transfusion rate. Median length of stay was 4 days. There were no oncological positive margins or recurrence after a median follow-up of 2 years.
  
  
  CONCLUSIONS
  Our data support the notion that Australian urological trainees can perform the majority of OPN cases, with equivalent oncological outcomes. We would advocate that when an OPN is being performed, the supervising consultant should use the case as an adjuvant for open renal surgery training.
authors.affiliation: Department of Urology, Fremantle Hospital, Fremantle, Western Australia, Australia.|Department of Urology, St John of God Hospital, Perth, Western Australia, Australia.
authors.forename: Paige E
authors.identifier: http://orcid.org/0000-0001-7918-9499
authors.initials: PE
authors.lastname: Tucker
authors.affiliation: Department of Urology, Fremantle Hospital, Fremantle, Western Australia, Australia.|Department of Urology, The Royal Wolverhampton Hospital NHS Trust, Wolverhampton, UK.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Rukin
authors.affiliation: Department of General Surgery, Derriford Hospital, Plymouth, UK.
authors.forename: Gana
authors.initials: G
authors.lastname: Kugathasan
authors.affiliation: Department of Urology, Fremantle Hospital, Fremantle, Western Australia, Australia.
authors.forename: Jennifer P
authors.initials: JP
authors.lastname: Kong
authors.affiliation: Department of Urology, Fremantle Hospital, Fremantle, Western Australia, Australia.|Department of Urology, Rockingham Hospital, Rockingham, Western Australia, Australia.
authors.forename: David M A
authors.initials: DM
authors.lastname: Wallace
mesh_terms: D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000193:education / Q000379:methods* / Q000592:standards; D009392:Nephrectomy / Q000193:education / Q000379:methods* / Q000592:standards; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014904:Western Australia
keywords: open partial nephrectomy; renal cell carcinoma; surgical outcome; surgical training