title: Outcomes after laparoscopic living donor nephrectomy: comparison of two laparoscopic surgeons with different levels of expertise.
abstract: OBJECTIVE
  To test the effect of surgeon experience on donor and recipient outcomes after laparoscopic living donor nephrectomy (LLDN). Results of a LLDN expert were compared with those of an LLDN novice.
  
  
  METHODS
  Between October 2008 and October 2010 the last 20 cases of a series of 130 consecutive LLDNs, performed by an expert (EXP) were compared with the first 20 cases of an LLDN novice (NOV). Donor and recipient outcomes were evaluated. The novice was mentored by the expert during his initial four LLDN cases.
  
  
  RESULTS
  Donor and recipient demographics were not different between the two surgeon groups. Total operating time and warm ischaemia time during LLDN was significantly longer in the NOV group compared with the EXP group (273 min vs 147 min and 213 s vs 162 s, respectively). The incidence of donor complications was low in both groups. Length of hospital stay among donors did not differ between groups. Although delayed graft function, rejection rates and postoperative serum creatinine levels indicated slightly poorer recipient outcomes in the NOV group, differences did not reach statistical significance.
  
  
  CONCLUSIONS
  Mentoring by an experienced urological laparoscopist may help an LLDN novice to generate acceptable donor and recipient outcomes. Whether or not prolonged operating times and warm ischaemia times during the early phase of an LLDN experience are risk factors for impaired graft function needs further evaluation.
authors: Department of Urology, Charité Universitätsmedizin Berlin, Berlin, Germany. frank.friedersdorff@charite.de
authors: Frank
authors: F
authors: Friedersdorff
authors: Peter
authors: P
authors: Werthemann
authors: Hannes
authors: H
authors: Cash
authors: Carsten
authors: C
authors: Kempkensteffen
authors: Ahmed
authors: A
authors: Magheli
authors: Stefan
authors: S
authors: Hinz
authors: Johannes
authors: J
authors: Waiser
authors: Lutz
authors: L
authors: Liefeldt
authors: Kurt
authors: K
authors: Miller
authors: Serdar
authors: S
authors: Deger
authors: T Florian
authors: TF
authors: Fuller
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D051799:Delayed Graft Function / Q000209:etiology; D005260:Female; D006084:Graft Rejection / Q000209:etiology; D006801:Humans; D007674:Kidney Diseases / Q000601:surgery; D016030:Kidney Transplantation / Q000379:methods / Q000592:standards*; D010535:Laparoscopy / Q000193:education / Q000379:methods / Q000592:standards*; D059032:Learning Curve; D007902:Length of Stay; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods / Q000592:standards*; D009398:Nephrology / Q000193:education / Q000592:standards*; D061646:Operative Time; D012189:Retrospective Studies; D020858:Tissue and Organ Harvesting / Q000193:education / Q000379:methods / Q000592:standards*; D016896:Treatment Outcome; D052096:Warm Ischemia