A collaborative approach reduces the learning curve and improves outcomes in laparoscopic nephrectomy

Despite the proven advantages of laparoscopic nephrectomy, the absence of local expertise and paucity of formal laparoscopic training in urology residencies has delayed the introduction of this technique into many institutions. We analyzed the impact of an initiative driven by the minimally-invasive division of the Department of Surgery on reducing the learning curve for hand-assisted laparoscopic nephrectomy (HALN) and maintaining good patient outcomes.

A retrospective chart review was performed on all laparoscopic renal procedures performed at Greenville Memorial Hospital University Medical Center. A collaborative effort between an fellowship-trained laparoscopic surgeon and an urologist began in August 2005. The data from the first 25 procedures performed in collaboration with general surgery were compared to the first 25 cases by urology alone.

The breakdown of cases was similar in the collaborative group (22 radical/3 partial) and the urology alone group (21 radical/4 partial). The indication for nephrectomy was cancer in the majority of cases. The operative times were longer in the collaborative group (236 v. 163 min; p < 0.001). With general surgery collaboration, estimated blood loss (107 v. 757 ml; p = 0.005), need for transfusion (2 v. 9 pts; p = 0.037), and conversion to open (1 pt v. 9 pts; p = 0.011) were all significantly reduced when compared to urologists alone.

An initiative by general surgery to facilitate the introduction of laparoscopic renal surgery can result in substantial improvement in perioperative patient outcomes. Collaboration with urologists and laparoscopic surgeons allows for the introduction of advanced minimally invasive techniques with a reduced learning curve compared to urologists alone.