Outcomes of laparoscopic partial nephrectomy after fellowship training.

Background And Objectives: Experienced surgeons at select high-volume centers have reported favorable outcomes of laparoscopic partial nephrectomy (LPN) in their contemporary experience. However, it is unclear whether recently fellowship-trained surgeons can replicate such outcomes. We evaluated LPNs performed by 3 surgeons in their initial years of independent practice following laparoscopic fellowship training.

Methods: Prospectively maintained databases were queried for LPNs performed during the first 3.5 years of practice. Intraoperative parameters, oncological efficacy, and postoperative complications were analyzed.

Results: Of 138 total LPNs (76 left, 62 right), the mean patient age was 57 years, mean tumor size was 2.52cm, and mean depth of invasion was 1.68cm. Mean OR time was 252 minutes, mean warm ischemia time (WIT) was 26 minutes, and mean estimated blood loss (EBL) was 202 mL. Complications occurred in 7 patients (5%), and conversions occurred in 9 patients (7%). Comparison of the first 15 vs. the last 15 cases demonstrated a significant reduction in mean OR time (204 min vs. 253 min, P=0.007), and mean WIT (24 min vs. 32 min, P<0.001). No significant change was demonstrated for tumor size (2.6 cm vs. 2.4 cm, P=0.390) or EBL (226 mL vs. 220 mL, P=0.922).

Conclusion: Newly fellowship-trained surgeons performing LPN achieve initial outcomes comparable to those reported by highly experienced surgeons. Further experience reduced total operative and warm ischemia times.