AB054. Learning curve and RENAL score co-affect the outcomes of retroperitoneal laparoscopic partial nephrectomy

Objective: To report our laparoscopic partial nephrectomy (LPN) experience and assess the role of learning curve and RENAL score impact on the outcomes of LPN, focusing on shortening the procedure time and preventing complications.

Methods: All 90 cases of retroperitoneal LPN performed by a single surgeon from June 2010 to December 2012 were enrolled. To assess learning curve effect the outcomes of LPN, 90 cases were divided into three groups (LPN A, LPN B, LPN C) of 30 cases based on when they occurred. To evaluate RENAL score impact on the outcomes of LPN, 90 cases were divided into three groups (high, mid, low) based on RENAL score. Outcomes were analyzed the following: operative time (OT), warm ischemia time (WIT), operative blood loss (OBL), perioperative complications, change of serum creatinine (△SCr) and change of GFR (△GFR).

Results: OT (LPN A 153.67±18.10 min, LPN B 146.00±16.94 min, LPN C 141.35±17.76 min, P=0.027), WIT (LPN A 38.03±4.76 min, LPN B 35.50±4.47 min, LPN C 31.60±5.28 min, P<0.001), and OBL (LPN A 184.33±31.25 mL, LPN B 164.33±27.38 mL, LPN C 142.00±27.22 mL, P<0.001) decreased with increasing surgeon experience. OT (high 164.00±19.57 min, mid 147.06±18.18 min, low 140.73±13.30 min, P<0.001), WIT (high 37.00±5.50 min, mid 33.12±5.22 min, low 30.80±3.93 min, P<0.001) and △SCr (high 0.06±0.04 mg/dL, mid −0.02±0.15 mg/dL, low 0.00±0.04 mg/dL, P=0.026) were inversely correlated with RENAL score. RENAL score also affect the outcomes of each LPN eras. Eleven complications were observed in 11 cases (11/90, 12.2%), Complications rate were similar with LPN A (5/30, 16.7%), LPN B (3/30, 10%) and LPN C (3/30,10%) P=0.780. However, there were significant differences between high REANL score (5/15, 33.3%), mid RENAL score (3/34, 8.8%) and low RENAL score (3/41, 7.8%) P=0.034. When considering the effects of both LPN eras and RENAL score, no synergistic effects were observed.

Conclusions: Learning curve and RENAL score impact on the outcomes of retroperitoneal laparoscopic partial nephrectomy were independent, and RENAL score also influence the outcomes of each LPN ears. We can select the appropriate cases based on the REANL score in the early stage of LPN may contribute to shortening the procedure time and preventing complications.

Keywords: RENAL score; retroperitoneal laparoscopic partial nephrectomy; retroperitoneal laparoscopic partial nephrectomy