Urology Resident Partial Nephrectomy Scoresheet

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Demographic Information

Date *

YYYY/MM/DD

YYYY

Scorer Name *

Trainee Name *

Trainee Level *

Assistant Name *

Assistant Level *

MIS Access

Access to the peritoneum is established in standard fashion using either Veress needle, Hasson cut down, or open access technique and insufflation of the peritoneum is performed. *

All steps in this procedure are to be conducted with an intent towards utmost patient safety and avoiding inadvertent intraabdominal injury.

worse

better

Localization of the kidney and placement of the remaining working ports. *

The practitioner should identify the target organ of interest and triangulate the working ports appropriately with demonstration of knowledge of port placement rationale and geometry.

worse

better

Dissection

Dissection of the incision of the peritoneum overlying the ureter and kidney. *

The practitioner should incise in the standard fashion along the white line of Toldt, reflect the peritoneum and bowel medially, identify the ureter and elevate it tracking it up into the renal sinus. The practitioner should make conscious effort towards formal identification of the ureter and its obvious and continued protection during this step of the procedure

worse

better

Dissection of the renal hilum *

The practitioner must execute appropriate care and skill in skeletonizing the renal vessels in preparation for hilar clamping achieving an adequate window cranially and caudally to the major hilar vessels

worse

better

Complete mobilization of the renal unit *

The practitioner must completely mobilize the target renal unit in preparation for the putative tumor resection, understanding the rationale for complete mobilization prior to resection and reconstruction

worse

better

Identification of the target site *

The practitioner should as previously agreed mark out an appropriate-sized wedged through the mid to lower pole aspect of the target renal unit using electrocautery. The minimum wedge width should be 2 cm in maximum transverse diameter at its widest point. Intent on entering the collecting system proper should be assumed

worse

better

Vascular control of the hilum *

The practitioner should place an additional working port if not already placed in preparation for vascular clamping of the renal hilum. The geometry of this port must be compatible with the adjusting working ports and the camera port. The additional vascular clamping port may be placed in either a cranial or caudad position relative to the camera port per the practitioner’s preference

worse

better

Resection / Reconstruction

Resection of the renal lesion *

Following vascular control of the entire renal unit the practitioner will then resect the putative renal lesion according to the marked out territory in the previous step 4.1. Appropriate manipulation of the kidney in order to facilitate resection angles and depth will be assessed. Resection completion according to planning stages will be compared and evaluated. Collecting system entry must be demonstrated. Use of an assistant port may be warranted

worse

better

Closure of the collecting system bed with a running suture must be performed *

Appropriate closure with tight sutures and a good running technique with appropriate anchoring of ends; either tied or clipped.

worse

better

Placement of hemostatic material such as FloSeal, Surgiflo, Tisseel, Evicel, Bioglue or other agent may be performed at this stage plus minus the addition of the Surgicel bolsters *

Surgeons choice, should be under the parenchymal stitches for the bolsters

worse

better

Closure of the renal parenchymal defect must be performed either by free-hand suturing over top of bolsters with appropriate compression of the renal parenchyma or placement of sutures across the parenchyma with compression with Hem-o-lok clips or placement of suture across the renal defect with compression of the parenchyma with Lapra-Tys *

Adequate approximation of the renal defect edges, good suturing technique, anchoring method at surgeon discretion

worse

better

Removal of the vascular clamp *

The practitioner should take appropriate care in the removal of the vascular clamp from the hilum and evaluation of hemostasis from the resection site

worse

better

Post hoc final questions

90 minute procedure time? *

Choose one:

Yes

Required

Less than 25 minute WIT time? *

Choose one:

Yes

Required

Hemostatic reconstruction? *

Choose one:

Yes

Required

Significant complications? *

Choose one:

Yes

Other:

Required

Assessment of Laparoscopic Skills *

General comment of MIS skills perception

worse

better

Overall conduct of a surgical procedure? *

General comment of surgical conduct

worse

better

Overall safety of the surgical procedure? *

General comment of surgical safety

worse

better

Please supply any notes specific to this assessment; general or specific which will assist in clarifying any details regarding this report or aspect of the procedure.

All information is confidential and blinded to the trainee

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