Department of Urology, Charité Universitätsmedizin Berlin, Berlin, Germany.
BJU Int. 2013 Jan;111(1):95-100. doi: 10.1111/j.1464-410X.2012.11348.x. Epub 2012 Jul 3.
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.
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.
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.
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.
检验腹腔镜活体供肾切取术（LLDN）中术者经验对供者和受者结局的影响。将一位 LLDN 专家的结果与一位 LLDN 新手的结果进行比较。
2008 年 10 月至 2010 年 10 月，对连续 130 例 LLDN 中最后 20 例（专家组）与一位新手进行的前 20 例（新手组）进行比较。评估供者和受者的结局。在新手进行的最初 4 例 LLDN 中，由专家对其进行指导。
两组术者的供者和受者的人口统计学特征无差异。新手组的总手术时间和 LLDN 中热缺血时间明显长于专家组（分别为 273 分钟比 147 分钟和 213 秒比 162 秒）。两组供者并发症发生率均较低。供者的住院时间无组间差异。尽管 NOV 组的延迟移植物功能、排斥率和术后血清肌酐水平表明受者结局稍差，但差异无统计学意义。
由经验丰富的泌尿外科腹腔镜医师进行指导可能有助于新手获得可接受的供者和受者结局。LLDN 经验早期手术时间和热缺血时间延长是否为移植物功能受损的危险因素需要进一步评估。
