Open partial nephrectomy: an ideal modular based training operation?

1. No. 190 Open partial nephrectomy: an ideal modular based training operation? Gana Kugathasan1, Ai Lok1, Victoria R Lewis1, Dickon Hayne1,2, Nicholas J Rukin1,3, D Michael Wallace1,2 1. Department of Urological Surgery, Fremantle Hospital, Western Australia 2. School of Surgery, University of Western Australia 3. Department of Urological Surgery, New Cross Hospital, Wolverhampton, UK Posters Proudly Supported by: Results 39 patients underwent an open partial nephrectomy. Median age was 56 years old, with a male to female ratio of 2.5:1. Five patients had an absolute indication for open partial nephrectomy, 3 relative and 31 elective indications for nephron sparing surgery. Median operative time was 153 minutes (85-243 minutes). The mean tumour size was 28mm (10-47mm), with a median cold ischaemic time of 31 minutes (12-43 minutes). Histology revealed 31 renal cell carcinomas and 8 benign tumours (20%). There were no positive tumour margins and our mean tumour margin clearance was 2.3mm (0.1-7 mm). There was no radiological evidence of recurrence at median follow up of 11 months. Mean increase in post operatively creatinine at last clinical review was 8 umol/L. Median length of stay was 4 days (Range 3-14 days). Complications There were no urinary leaks in this series. Introduction With the advent of laparoscopic surgery, trainee’s experience of open renal surgery is becoming limited. Renal access and mobilisation, as well as hilum control are becoming diminishingly taught operative skills. Our trainees are taught open partial nephrectomy in a modular based structure including incision, vessel and ureteric localisation, kidney mobilisation, tumour excision and kidney reconstruction. Aim We performed a retrospective review of our trainee performed procedures to determine whether the outcome are satisfactory and if this would be an appropriate training operation. • Methods • We report a retrospective series of all open partial nephrectomy performed over a 3-year period from 2010 to 2012. All procedures were supervised by a senior, experienced urological consultant. Under their guidance and assistance, our trainees performed components of the operation as modular steps. • Data collection included: • Surgical Indication • Operative time • Cold ischaemic time • Renal function recovery post procedure • Tumour margin status • Tumour recurrence • Complications Conclusions In our experience open partial nephrectomy is an excellent training operation, particularly with respect to the principles of open renal surgery. Our data demonstrates safe and comparable outcomes to the contemporary literature. We advocate that a supervised, modular based approach is required, with an experienced supervising consultant. Acknowledgements None disclosed References: Kowalczyk KJ et al, Comparative effectiveness, costs and trends in treatment of small renal masses from 2005 to 2007. BJU Int. 2013 Mar 4. doi: 10.1111/j.1464-410X.2012.11776.x. Reifsnyder JE et al, Laparoscopic and open partial nephrectomy: complication comparison using the Clavien system. JSLS. 2012 Jan-Mar;16(1):38-44. doi: 10.4293/108680812X13291597716942.