Incorporation of hand-assisted laparoscopic nephrectomy into an academic training program: an assessment of the utility of a 3-month minifellowship.

Introduction: 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.

Materials And 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.