711 THE IMPACT OF THE MINIMALLY INVASIVE CARE PATHWAY ON CONTEMPORARY OPEN PARTIAL NEPHRECTOMY

You have accessJournal of UrologyKidney Cancer: Evaluation and Staging II1 Apr 2012711 THE IMPACT OF THE MINIMALLY INVASIVE CARE PATHWAY ON CONTEMPORARY OPEN PARTIAL NEPHRECTOMY Angela M. Fast, Piruz Motamedinia, Michael J. Lipsky, Gregory W. Hruby, and James M. McKiernan Angela M. FastAngela M. Fast New York, NY More articles by this author , Piruz MotamediniaPiruz Motamedinia New York, NY More articles by this author , Michael J. LipskyMichael J. Lipsky New York, NY More articles by this author , Gregory W. HrubyGregory W. Hruby New York, NY More articles by this author , and James M. McKiernanJames M. McKiernan New York, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.795AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A shift from open to minimally invasive surgery (MIS) has occurred over the last decade for partial nephrectomy. This trend may be attributed to benefits of MIS such as decreased blood loss, pain and recovery time as well as improved cosmetic results. Our objective is to examine how MIS care pathway has impacted peri-operative measures of open partial nephrectomy in a contemporary series. METHODS Patients were retrospectively identified who underwent open (n=353) or minimally invasive (laparoscopic or robotic, n=214) partial nephrectomy for renal masses between 2000-2011. Patients were divided by year of surgery into early (2000-05) and late (2006-11) periods to reflect the early MIS and established MIS eras at our institution. Patient tumor and peri-operative factors were compared across these eras. RESULTS A total of 159 and 194 patients underwent open partial nephrectomy during the early and late eras of MIS and 38 and 176 underwent MIS for their partial nephrectomy during the early and late eras, respectively. The proportion of patients with stage cT1a (p<0.001) and cT1b (p=0.004) undergoing open surgery has decreased between the eras with a concurrent increase in rates of MIS. There has been no change in the proportion of patients with cT2 or greater stage undergoing open surgery. The mean tumor diameter is significantly larger in the late era for both open (3.36 vs. 3.94, p=0.01) and MIS (2.12 vs. 2.90, p=0.02). The mean length of stay (LOS) has shortened between the eras for both open (4.73 vs. 3.46 days, p<0.001) and MIS (2.95 vs. 2.21, p=0.003) procedures. This may be attributable to the increased use of regional in addition to general anesthesia (20% vs 32%, p=0.011) in patients undergoing open surgery. There were no differences in post-op complications rates between eras (p=0.21 and p=0.13). CONCLUSIONS With the broadening indication of MIS for small and medium sized tumors, the utility of open partial nephrectomy is reserved for larger and more complex masses than previously observed. Despite these factors, LOS following open surgery has significantly decreased while post-op complication rates remain unchanged. These observations demonstrate the beneficial impact of MIS care pathways, illustrating the transference of this acquired experience to open surgery. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e291-e292 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Angela M. Fast New York, NY More articles by this author Piruz Motamedinia New York, NY More articles by this author Michael J. Lipsky New York, NY More articles by this author Gregory W. Hruby New York, NY More articles by this author James M. McKiernan New York, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...