title: Impact of fellowship training in initiating a laparoscopic donor nephrectomy program.
abstract: OBJECTIVE
  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.
authors: Department of Surgery, Medical College of Georgia, Augusta, Georgia 30912-4050, USA
authors: Kamran P
authors: KP
authors: Sajadi
authors: James J
authors: JJ
authors: Wynn
authors: James A
authors: JA
authors: Brown
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D005257:Fellowships and Scholarships; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D010535:Laparoscopy; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000193:education*; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D014572:Urology / Q000193:education*