Description:
<jats:sec><jats:title>What's known on the subject? and What does the study add?</jats:title><jats:p><jats:list list-type="bullet">
<jats:list-item><jats:p>Laparoscopic living donor nephrectomy has evolved as the procurement method of choice for living kidney donation. Given that this is a technically challenging procedure with potential risks for the healthy donor, skills transfer from an experienced laparoscopist to a novice is critical.</jats:p></jats:list-item>
<jats:list-item><jats:p>The present study investigates donor and recipient outcomes during a novice's early experience with this procedure. Previous training in laparoscopic renal surgery and mentoring by the expert helps the novice to generate acceptable outcomes. However, longer warm ischaemia times during the learning phase may affect short‐term graft function.</jats:p></jats:list-item>
</jats:list></jats:p></jats:sec><jats:sec><jats:title>Objective</jats:title><jats:p><jats:list list-type="bullet">
<jats:list-item><jats:p>To test the effect of surgeon experience on donor and recipient outcomes after laparoscopic living donor nephrectomy (<jats:styled-content style="fixed-case">LLDN</jats:styled-content>). Results of a <jats:styled-content style="fixed-case">LLDN</jats:styled-content> expert were compared with those of an <jats:styled-content style="fixed-case">LLDN</jats:styled-content> novice.</jats:p></jats:list-item>
</jats:list></jats:p></jats:sec><jats:sec><jats:title>Patients and Methods</jats:title><jats:p><jats:list list-type="bullet">
<jats:list-item><jats:p>Between <jats:styled-content style="fixed-case">O</jats:styled-content>ctober 2008 and <jats:styled-content style="fixed-case">O</jats:styled-content>ctober 2010 the last 20 cases of a series of 130 consecutive <jats:styled-content style="fixed-case">LLDNs</jats:styled-content>, performed by an expert (<jats:styled-content style="fixed-case">EXP</jats:styled-content>) were compared with the first 20 cases of an <jats:styled-content style="fixed-case">LLDN</jats:styled-content> novice (<jats:styled-content style="fixed-case">NOV</jats:styled-content>).</jats:p></jats:list-item>
<jats:list-item><jats:p>Donor and recipient outcomes were evaluated.</jats:p></jats:list-item>
<jats:list-item><jats:p>The novice was mentored by the expert during his initial four <jats:styled-content style="fixed-case">LLDN</jats:styled-content> cases.</jats:p></jats:list-item>
</jats:list></jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p><jats:list list-type="bullet">
<jats:list-item><jats:p>Donor and recipient demographics were not different between the two surgeon groups.</jats:p></jats:list-item>
<jats:list-item><jats:p>Total operating time and warm ischaemia time during <jats:styled-content style="fixed-case">LLDN</jats:styled-content> was significantly longer in the <jats:styled-content style="fixed-case">NOV</jats:styled-content> group compared with the <jats:styled-content style="fixed-case">EXP</jats:styled-content> group (273 min vs 147 min and 213 s vs 162 s, respectively).</jats:p></jats:list-item> <jats:list-item><jats:p>The incidence of donor complications was low in both groups. Length of hospital stay among donors did not differ between groups.</jats:p></jats:list-item>
<jats:list-item><jats:p>Although delayed graft function, rejection rates and postoperative serum creatinine levels indicated slightly poorer recipient outcomes in the <jats:styled-content style="fixed-case">NOV</jats:styled-content> group, differences did not reach statistical significance.</jats:p></jats:list-item>
</jats:list></jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p><jats:list list-type="bullet">
<jats:list-item><jats:p>Mentoring by an experienced urological laparoscopist may help an <jats:styled-content style="fixed-case">LLDN</jats:styled-content> novice to generate acceptable donor and recipient outcomes.</jats:p></jats:list-item>
<jats:list-item><jats:p>Whether or not prolonged operating times and warm ischaemia times during the early phase of an <jats:styled-content style="fixed-case">LLDN</jats:styled-content> experience are risk factors for impaired graft function needs further evaluation.</jats:p></jats:list-item>
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