Impact of fellowship training in initiating a laparoscopic donor nephrectomy program

Kamran Sajadi, James J. Wynn, James A. Brown

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objectives: Laparoscopic donor nephrectomy (LDN) is the current standard of care, but remains a challenging procedure. A urologist at our center performed 6 months of standard and hand-assisted laparoscopic nephrectomy (HALN) fellowship (46 cases, 30 as surgeon). He subsequently performed 30 HAL renal surgeries prior to initiating our hand-assisted laparoscopic donor nephrectomy (HALDN) program. Methods: We reviewed the intra- and postoperative outcomes of the first 20 HALDNs performed at our center. We examined demographics, estimated blood loss (EBL), operative time, complications, change in hemoglobin and creatinine, length of hospital stay, warm ischemic time, and recipient outcome. Results: Twenty (20) patients underwent HALDN between November 2003 and December 2005. The mean operative time was 277 minutes. EBL averaged 176 mL. An expected rise in creatinine of 0.1-0.8 mg/dL occurred in all patients. One (1) patient had a splenic abrasion and was transfused intraoperatively. Two (2) patients' courses were complicated by ileus. The remaining patients were discharged on postoperative days 2-6. There were no other complications. Warm ischemia time averaged 3.7 minutes. Two (2) recipients experienced acute or delayed rejection episodes, requiring increased immunosuppression. One (1) recipient had good renal function until he developed sepsis 3 months later and died. All recipients were discharged with functioning grafts, and there have been no ureteral strictures. Conclusions: Six (6) months of laparoscopic nephrectomy training plus a 30-case HAL/LRN surgical experience sufficiently prepares a surgeon to initiate a HALDN program. Even at a lower volume transplant center, positive operative results and long-term graft outcomes can be achieved.

Original languageEnglish (US)
Pages (from-to)425-428
Number of pages4
JournalJournal of Laparoendoscopic and Advanced Surgical Techniques
Volume17
Issue number4
DOIs
StatePublished - Aug 2007
Externally publishedYes

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Nephrectomy
Tissue Donors
Hand
Warm Ischemia
Operative Time
Transplants
Length of Stay
Creatinine
Kidney
Ileus
Standard of Care
Immunosuppression
Sepsis
Pathologic Constriction
Hemoglobins
Demography

ASJC Scopus subject areas

  • Surgery

Cite this

Impact of fellowship training in initiating a laparoscopic donor nephrectomy program. / Sajadi, Kamran; Wynn, James J.; Brown, James A.

In: Journal of Laparoendoscopic and Advanced Surgical Techniques, Vol. 17, No. 4, 08.2007, p. 425-428.

Research output: Contribution to journalArticle

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