Hand-assisted laparoscopic nephrectomy: The transfer of experience to a new academic center

Background and Purpose: Hand-assisted laparoscopic nephrectomy (HALN) has become widely used for the management of localized renal masses. Centers of excellence have slowly disseminated this surgical approach throughout academic institutions and private practices. The transfer of this technique to inexperienced surgeons and centers has not been well studied. We examined our outcomes for HALN with an experienced surgeon at a new academic center. Patients and Methods: Thirty-six patients underwent HALN for benign or malignant disease over an 8-month period, with two fellows and three chief residents under the guidance of one attending surgeon performing all procedures. Parameters measured included age, ASA score, body mass index (BMI), operative time, estimated blood loss, number of trocars used, time to oral intake, analgesics required, length of stay, and complications. There was a slight predominance of right-sided lesions. The average patient age was 55 years (range 39-87 years) and the mean ASA score 2.3 (2-4). The mean BMI was 28.6 (range 20-46). Results: All cases were completed without open conversion. The total operative time averaged 175 minutes (range 118-257 minutes), with 80% patients requiring two trocars. The average blood loss was 141 mL, and there were no transfusions. The mean time to oral intake was 17.1 hours (range 1.5-240 hours), the average length of stay was 4.3 days (range 1-28 days), and the total narcotic requirement averaged 111 mg of morphine sulfate equivalents (range 6.7-519 mg). Significant complications included one diaphragm injury (repaired laparoscopically), one postoperative pulmonary embolus, pancreatitis in two patients, and one case of pneumonia. There were no deaths. Conclusions: The HALN techniques can be transferred quickly and efficiently from one center to another under the guidance of an experienced surgeon. Operative times are acceptable, with complication rates comparable to those in previously reported series.