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Initiation of an advanced laparoscopic surgery program requires skill and proper training. Despite description of multiple surgical training modules, an ideal method for training of surgeons for advanced laparoscopic procedures is lacking. We propose an abbreviated self-imposed proctored preceptorship training model as the optimum training method for training skilled laparoscopic surgeons in advanced laparoscopic procedures like laparoscopic donor nephrectomy. The laparoscopic donor nephrectomy program was started at the Institute using preceptorship-proctorship model. One hundred left laparoscopic donor nephrectomies were performed over the course of 2 years. Outcomes in terms of performance related (Surgeon) outcomes in the form of learning curve and patient outcomes in terms of donor outcomes and recipient results and were studied. Learning curve was calculated using the moving average method and calculation of mean operative time of every five consecutive cases. Mean operative time for laparoscopic donor nephrectomy was 108.1 ± 26.5 min, the warm ischemia time averaged at 3.5 ± 1.3 min and the mean blood loss was 130.1 ± 54.9 ml. Moving average analysis revealed that approximately 20 LDN cases were needed to complete the learning phase. According to the mean operative time of every five consecutive cases, learning phase of LDN was completed between 26 and 30 cases. We believe that the abbreviated self-imposed proctored preceptorship model of training is an optimum model for starting a new advanced laparoscopic surgery program and can help surgeons to overcome the initial learning curve. [ABSTRACT FROM AUTHOR]

Introduction: To evaluate our experience for live donor Nephrectomy with respect to donor safety and graft function. Methods: All the donor nephrectomies were included from June 2004 and Jan 2008. The data regarding operative time, intraoperative complications, the warm ischemia time, and the donor morbidities, hospital stay and graft outcome were recorded. Results: 332 Laparoscopic donor Nephrectomies were performed in this period. The average age was 32 years (range18-62) with 85 men and 247 women donors. 315(94.87%) were left nephrectomies. 75 kidneys had multiple multiple vessels, (65 - double arteries, 4 - triple arteries 5 - double veins and 1 - triple veins). The overall operative time was 90-360 min (mean180 min), and warm ischemia time was 3-12 (3.85) min. On three occasions the procedure was converted to open due bleed from the internal iliac artery aneurysm, injury to the spleen and technical reasons. 45 (13.55%) patients had complications with most of them in the initial experience. At one year follow-up of first 200 cases the graft function was stable and the acute rejection rate of 33% comparable to open surgery was noted. The outcome did not differ in cases with multiple renal vessels. There were no mortalities, and no graft loss. The overall hospital stay was 2-5 days and most of the patients were discharged on the 2nd postoperative day. Conclusions: Laparoscopic Nephrectomy is a safe and standard procedure for graft harvesting with early doner convalescence and good graft outcome. [ABSTRACT FROM AUTHOR]