TY - JOUR
T1 - Impact of fellowship training in initiating a laparoscopic donor nephrectomy program
AU - Sajadi, Kamran P.
AU - Wynn, James J.
AU - Brown, James A.
N1 - Funding Information:
This study was supported by the U.S. Department of Energy , Office of Fossil Energy, as the National Energy Technology Laboratory's ongoing research. Part of the research was also supported by National Science Foundation grant (NSF DEB-1342732 ) awarded to Sharma. We thank the staff of the Stable Isotope Lab at West Virginia University for collecting the Marcellus PW samples, B. Stewart and R. Capo for providing clean lab space for sample preparation, M. Stuckman for assistance with IC and TOC analysis, C. Hite for assistance with radiogenic Sr isotope analysis, and D. Bain for technical support with ICP-MS analysis. This research was supported in part by an appointment to the National Energy Technology Laboratory Research Participation Program, sponsored by the U.S. Department of Energy and administered by the Oak Ridge Institute for Science and Education (TTP). The manuscript was supported in part by the University of Waterloo start‐up grant (TTP).
PY - 2007/8
Y1 - 2007/8
N2 - Objectives: Laparoscopic donor nephrectomy (LDN) is the current standard of care, but remains a challenging procedure. A urologist at our center performed 6 months of standard and hand-assisted laparoscopic nephrectomy (HALN) fellowship (46 cases, 30 as surgeon). He subsequently performed 30 HAL renal surgeries prior to initiating our hand-assisted laparoscopic donor nephrectomy (HALDN) program. Methods: We reviewed the intra- and postoperative outcomes of the first 20 HALDNs performed at our center. We examined demographics, estimated blood loss (EBL), operative time, complications, change in hemoglobin and creatinine, length of hospital stay, warm ischemic time, and recipient outcome. Results: Twenty (20) patients underwent HALDN between November 2003 and December 2005. The mean operative time was 277 minutes. EBL averaged 176 mL. An expected rise in creatinine of 0.1-0.8 mg/dL occurred in all patients. One (1) patient had a splenic abrasion and was transfused intraoperatively. Two (2) patients' courses were complicated by ileus. The remaining patients were discharged on postoperative days 2-6. There were no other complications. Warm ischemia time averaged 3.7 minutes. Two (2) recipients experienced acute or delayed rejection episodes, requiring increased immunosuppression. One (1) recipient had good renal function until he developed sepsis 3 months later and died. All recipients were discharged with functioning grafts, and there have been no ureteral strictures. Conclusions: Six (6) months of laparoscopic nephrectomy training plus a 30-case HAL/LRN surgical experience sufficiently prepares a surgeon to initiate a HALDN program. Even at a lower volume transplant center, positive operative results and long-term graft outcomes can be achieved.
AB - Objectives: Laparoscopic donor nephrectomy (LDN) is the current standard of care, but remains a challenging procedure. A urologist at our center performed 6 months of standard and hand-assisted laparoscopic nephrectomy (HALN) fellowship (46 cases, 30 as surgeon). He subsequently performed 30 HAL renal surgeries prior to initiating our hand-assisted laparoscopic donor nephrectomy (HALDN) program. Methods: We reviewed the intra- and postoperative outcomes of the first 20 HALDNs performed at our center. We examined demographics, estimated blood loss (EBL), operative time, complications, change in hemoglobin and creatinine, length of hospital stay, warm ischemic time, and recipient outcome. Results: Twenty (20) patients underwent HALDN between November 2003 and December 2005. The mean operative time was 277 minutes. EBL averaged 176 mL. An expected rise in creatinine of 0.1-0.8 mg/dL occurred in all patients. One (1) patient had a splenic abrasion and was transfused intraoperatively. Two (2) patients' courses were complicated by ileus. The remaining patients were discharged on postoperative days 2-6. There were no other complications. Warm ischemia time averaged 3.7 minutes. Two (2) recipients experienced acute or delayed rejection episodes, requiring increased immunosuppression. One (1) recipient had good renal function until he developed sepsis 3 months later and died. All recipients were discharged with functioning grafts, and there have been no ureteral strictures. Conclusions: Six (6) months of laparoscopic nephrectomy training plus a 30-case HAL/LRN surgical experience sufficiently prepares a surgeon to initiate a HALDN program. Even at a lower volume transplant center, positive operative results and long-term graft outcomes can be achieved.
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U2 - 10.1089/lap.2006.0152
DO - 10.1089/lap.2006.0152
M3 - Review article
C2 - 17705720
AN - SCOPUS:34548095652
SN - 1092-6429
VL - 17
SP - 425
EP - 428
JO - Journal of Laparoendoscopic and Advanced Surgical Techniques
JF - Journal of Laparoendoscopic and Advanced Surgical Techniques
IS - 4
ER -