title: Impact of surgical training and surgeon's experience on early outcome in kidney transplantation.
abstract: OBJECTIVE
  The purpose of this study was to assess the impact of surgical training and surgeon's experience on surgical quality and early outcome parameters.
  
  
  METHODS
  The outcomes of 184 deceased donor kidney transplant procedures were retrospectively reviewed. Intraoperative quality parameters, complication rates, and early outcome parameters were analyzed with respect to surgeon's experience. Surgeons were grouped according to their level of experience: trainees (n = 5), who were senior residents in their transplant rotation; low-experience surgeons (n = 4), who had an individual caseload of at least 30 supervised procedures; medium-experience surgeons (n = 5), who had an individual caseload of a minimum of 30 unsupervised (+30 supervised) procedures; and high-experience surgeons (n = 2), who had an individual caseload of more than 200 procedures.
  
  
  RESULTS
  Surgical training was offered in 20 % of all cases. Surgeons with a high experience in kidney transplantation had a significantly lower warm ischemic time (30 versus 35 min, p = 0.01) and total operation time (135 versus 155 min, p = 0.43) as compared to the other study groups. However, this did not translate into a better outcome after transplantation. The complication rate and early outcome parameters such as length of hospital stay, serum creatinine at discharge, and graft and patient survival at 3 months post TX did not show any significant difference between the groups.
  
  
  CONCLUSIONS
  We conclude that hands-on training of residents in kidney transplantation is feasible and surgical experience can be safely gained within a staged surgical training program.
authors.affiliation: Department of Surgery, University of Munich, Großhadern, Munich, Germany. michael.thomas@med.uni-muenchen.de
authors.forename: Michael
authors.initials: M
authors.lastname: Thomas
authors.forename: Markus
authors.initials: M
authors.lastname: Rentsch
authors.forename: Moritz
authors.initials: M
authors.lastname: Drefs
authors.forename: Joachim
authors.initials: J
authors.lastname: Andrassy
authors.forename: Bruno
authors.initials: B
authors.lastname: Meiser
authors.forename: Manfred
authors.initials: M
authors.lastname: Stangl
authors.forename: Karl-Walter
authors.initials: KW
authors.lastname: Jauch
authors.forename: Markus
authors.initials: M
authors.lastname: Guba
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D003404:Creatinine / Q000097:blood; D003479:Curriculum; D005240:Feasibility Studies; D005260:Female; D005858:Germany; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D007396:Internship and Residency; D016030:Kidney Transplantation / Q000193:education*; D007902:Length of Stay; D008297:Male; D008611:Mentors; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D013996:Time and Motion Studies; D016896:Treatment Outcome; D052096:Warm Ischemia; D055815:Young Adult
chemical_list: D003404:Creatinine