[Preparation for clinical introduction of advanced laparoscopic procedures: laparoscopic renal autotransplantation].
BACKGROUND
After long term clinical training at teaching hospitals, individuals or complete teams have reported on the establishment of laparoscopic nephrectomy and prostatectomy. This, however, is difficult to realize at many clinics due to the current staffing situation. In the following an alternative approach will be presented.


METHODS
After 50 hours of practice on a pelvic trainer during which the laparoscopic handling and especially various suturing techniques were learnt (A) a total of 15 pigs (approx. 40 kg, in general aesthesia, right sided positioned, with 7 ports) have been operated from February to August 2006: 1. laparoscopic nephrectomy, 2. laparoscopic in-situ cold perfusion, 3. laparoscopic renal autotransplantation (B). Directly after this a two month clinical training at a recognized laparoscopic center took place (C).


RESULTS
After completion of phase A, an extended experimental operation phase B followed, marked by complications such as: bleeding (n=5), skin emphysemas (n=3), technical failures (n=2), non-optimal placement of ports (n=6), problems with placement the cold perfusion catheters (n=7), and unsuitable surgical instruments (n=2). Eleven laparoscopic nephrectomies were successful; only during the last three operations a sufficient end-to side anastomosis has been achieved (anastomosis time range 80110 min of which was 50% in cold ischemia). During the external clinical training (C) (through 2. and 1. assistance) five endoscopic extraperitoneal prostatectomies (surgery time range 145-235 min) and two radical nephrectomies have been independently carried out (180-230 min).


CONCLUSIONS
Using the pig model laparoscopic renal autotransplantation ideally combines ablative and reconstructive operation techniques. For this reason it is especially suitable for young urologists learning to perform nephrectomies and prostatectomies. For beginners in laparoscopy this entails long but mentor independent learning phases A, B thereby shortening the subsequent clinical training at the teaching hospital (C).
Reichelt
O
O
Klinik für Urologie, Friedrich-Schiller-Universität Jena, Lessingstrasse 1, 07740 Jena, Deutschland. olaf.reichelt@med.uni-jena.de
Borkowetz
A
A
Chyhrai
A
A
Tanovic
E
E
Weirich
T
T
Müller
T
T
Schubert
H
H
Schubert
J
J
D000714:Anastomosis, Surgical / Q000295:instrumentation / Q000379:methods; D000818:Animals; D050377:Cold Ischemia; D016030:Kidney Transplantation / Q000193:education / Q000295:instrumentation / Q000379:methods*; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D009392:Nephrectomy / Q000193:education / Q000295:instrumentation / Q000379:methods*; D011468:Prostatectomy / Q000295:instrumentation / Q000379:methods*; D013525:Surgical Instruments; D013552:Swine; D013996:Time and Motion Studies; D020858:Tissue and Organ Harvesting / Q000193:education / Q000295:instrumentation / Q000379:methods*