title: Retroperitoneoscopic nephrectomy for benign nonfunctioning kidneys: Training and outcome.
abstract: BACKGROUND
  Between the two techniques of laparoscopic nephrectomy, retroperitoneoscopy has certain distinct advantages over transperitoneal access but may be a more difficult technique to learn. We present our experience of training novices in retroperitoneoscopic nephrectomy with a good outcome, making it a standard of care for nephrectomy at our institute.
  
  
  METHODS
  The aim of this study was to report the initial experience, learning curve, and outcome of retroperitoneoscopic nephrectomy by novices under a mentored approach. The series included four novice urologists. The data from the initial forty retroperitoneoscopic nephrectomies performed by each of them were reviewed.
  
  
  RESULTS
  Retroperitoneoscopic nephrectomies were successfully completed by novices in 88.1% (141/160) of the patients. Nine cases (5.6%) required the mentor's help because of nonprogression, and ten cases (6%) required conversion to open nephrectomy. The median operative time of all surgeons decreased with increased surgical experience. There was some intersurgeon variation in the learning curve ranging from 10 to 30 cases, but all surgeons showed a significant reduction in operative time across consecutive sets of ten cases. Seven cases required mentor help in the initial series (7/80) and only two in later half of cases (2/80). All minor complications were also significantly less in the later series.
  
  
  CONCLUSIONS
  The present series represents the effectiveness of training in retroperitoneoscopic nephrectomy of novices by a responsible team and with the standard protocol and surgical steps. Through effective mentoring, the steep learning curve associated with retroperitoneoscopic nephrectomy has been overcome, making it standard of care for nephrectomy at our institute.
authors.affiliation: Department of Urology and Renal Transplantation, Smt. Gulabben Rasiklal Doshi and Smt. Kamlaben Mafatlal Mehta Institute of Kidney Diseases and Research Centre and Dr. H. L. Trivedi Institute of Transplantation Sciences, Civil Hospital Campus, Ahmedabad, Gujarat, India.
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Saifee
authors.affiliation: Department of Urology and Renal Transplantation, Smt. Gulabben Rasiklal Doshi and Smt. Kamlaben Mafatlal Mehta Institute of Kidney Diseases and Research Centre and Dr. H. L. Trivedi Institute of Transplantation Sciences, Civil Hospital Campus, Ahmedabad, Gujarat, India.
authors.forename: Ramya
authors.initials: R
authors.lastname: Nagarajan
authors.affiliation: Department of Urology and Renal Transplantation, Smt. Gulabben Rasiklal Doshi and Smt. Kamlaben Mafatlal Mehta Institute of Kidney Diseases and Research Centre and Dr. H. L. Trivedi Institute of Transplantation Sciences, Civil Hospital Campus, Ahmedabad, Gujarat, India.
authors.forename: Syed Javed
authors.initials: SJ
authors.lastname: Qadri
authors.affiliation: Department of Urology and Renal Transplantation, Smt. Gulabben Rasiklal Doshi and Smt. Kamlaben Mafatlal Mehta Institute of Kidney Diseases and Research Centre and Dr. H. L. Trivedi Institute of Transplantation Sciences, Civil Hospital Campus, Ahmedabad, Gujarat, India.
authors.forename: Amlan
authors.initials: A
authors.lastname: Sarmah
authors.affiliation: Department of Urology and Renal Transplantation, Smt. Gulabben Rasiklal Doshi and Smt. Kamlaben Mafatlal Mehta Institute of Kidney Diseases and Research Centre and Dr. H. L. Trivedi Institute of Transplantation Sciences, Civil Hospital Campus, Ahmedabad, Gujarat, India.
authors.forename: Suresh
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Department of Urology and Renal Transplantation, Smt. Gulabben Rasiklal Doshi and Smt. Kamlaben Mafatlal Mehta Institute of Kidney Diseases and Research Centre and Dr. H. L. Trivedi Institute of Transplantation Sciences, Civil Hospital Campus, Ahmedabad, Gujarat, India.
authors.forename: Bipin Chandra
authors.initials: BC
authors.lastname: Pal
authors.affiliation: Department of Urology and Renal Transplantation, Smt. Gulabben Rasiklal Doshi and Smt. Kamlaben Mafatlal Mehta Institute of Kidney Diseases and Research Centre and Dr. H. L. Trivedi Institute of Transplantation Sciences, Civil Hospital Campus, Ahmedabad, Gujarat, India.
authors.forename: Pranjal
authors.initials: P
authors.lastname: Modi
keywords: Benign nonfunctioning kidney; learning curve; retroperitoneoscopic nephrectomy