Hand-assisted partial nephrectomy with early arterial clamp removal: Impact of the learning curve

Nessn H Azawi, Thomas P Norus, Hans-Erik Wittendorff, Claus Dahl

Research output: Contribution to journalJournal articleResearchpeer-review


OBJECTIVE: The aims of this study were to present the results of hand-assisted laparoscopic partial nephrectomy according to the margin, ischaemia and complications system; to assess the role of the learning curve; and to compare this approach with other approaches.

MATERIAL AND METHODS: Data from 60 consecutive patients were obtained from a prospectively maintained database. The patients were divided into three cohorts (1, 2 and 3), with 20 patients each, according to their surgery dates.

RESULTS: The overall margin, ischaemia and complications rate was 90%. The warm ischaemia time was 9.5 min in cohort 1, decreasing to 5 min in cohort 3 (p < 0.0001). The Padua score (p = 0.0287) and tumour size (p = 0.0003) were significantly increased in cohort 3, but loss of kidney function decreased significantly to 3.5% in this cohort. Loss of kidney function of less than 5% was reported for eight (40%), nine (45%) and 14 (70%) patients in cohorts 1, 2 and 3, respectively (p = 0.0185).

CONCLUSIONS: Hand-assisted laparoscopic partial nephrectomy with early removal of arterial clamps is safe and easy to learn. An expert laparoscopic surgeon can perform hand-assisted laparoscopic partial nephrectomy for complex tumours with a relatively high success rate according to the margin, ischaemia and complications system. Warm ischaemia time could be obtained within 5 min after 40 procedures.

Original languageEnglish
JournalScandinavian Journal of Urology
Issue number6
Pages (from-to)538-543
Publication statusPublished - 1. Dec 2014


  • Early arterial clamp removal
  • Hospital stay
  • Learning curve
  • Partial nephrectomy
  • Warm ischaemia time


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