Expertization Research Articles

A Delphi Survey Study to Formulate Statements on the Treatability of Inherited Metabolic Disorders to Decide on Eligibility for Newborn Screening.

The Wilson and Jungner (W&J) and Andermann criteria are meant to help select diseases eligible for population-based screening. With the introduction of next-generation sequencing (NGS) methods for newborn screening (NBS), more inherited metabolic diseases (IMDs) can technically be included, and a revision of the criteria was attempted. This study aimed to formulate statements and investigate whether those statements could elaborate on the criterion of treatability for IMDs to decide on eligibility for NBS. An online Delphi study was started among a panel of Dutch IMD experts (EPs). EPs evaluated, amended, and approved statements on treatability that were subsequently applied to 10 IMDs. After two rounds of Delphi, consensus was reached on 10 statements. Application of these statements selected 5 out of 10 IMDs proposed for this study as eligible for NBS, including 3 IMDs in the current Dutch NBS. The statement: 'The expected benefit/burden ratio of early treatment is positive and results in a significant health outcome' contributed most to decision-making. Our Delphi study resulted in 10 statements that can help to decide on eligibility for inclusion in NBS based on treatability, also showing that other criteria could be handled in a comparable way. Validation of the statements is required before these can be applied as guidance to authorities.

MP68-09 VALIDATION OF AN OBJECTIVE PRESSURE TEST FOR URETHROVESICAL ANASTOMOSIS IN A NON-BIOHAZARDOUS ROBOT ASSISTED RADICAL PROSTATECTOMY SIMULATION MODEL

You have accessJournal of UrologyCME1 Apr 2023MP68-09 VALIDATION OF AN OBJECTIVE PRESSURE TEST FOR URETHROVESICAL ANASTOMOSIS IN A NON-BIOHAZARDOUS ROBOT ASSISTED RADICAL PROSTATECTOMY SIMULATION MODEL Nathan Schuler, Alexis Steinmetz, Kit Yuen, Lauren Shepard, Tyler Holler, Christopher Wanderling, and Ahmed Ghazi Nathan SchulerNathan Schuler More articles by this author , Alexis SteinmetzAlexis Steinmetz More articles by this author , Kit YuenKit Yuen More articles by this author , Lauren ShepardLauren Shepard More articles by this author , Tyler HollerTyler Holler More articles by this author , Christopher WanderlingChristopher Wanderling More articles by this author , and Ahmed GhaziAhmed Ghazi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003331.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urethrovesical Anastomosis (UVA) is a critical step within Robot Assisted Radical Prostatectomy (RARP) which directly influences postoperative complication and continence recovery. The current standard for assessing UVA proficiency is mainly through the Robotic Anastomosis Competency Evaluation (RACE), a subjective video-based grading system. We have previously validated embedded force sensors within realistic RARP models as an objective method to measure torque during nerve sparing. Herein, we developed an adjacent pressure test with parallels to common urodynamic testing as an objective metric to evaluate UVA integrity in our RARP simulation. METHODS: 48 simulated robotic UVA were completed by urologists with varying experience levels: 6 experts (EXP), 16 intermediates (IM) and 26 novices (NOV)). Following simulation, bladders were dissected from surrounding tissue and subjected to a pressure leak test. Bladders were filled to predetermined volumes at a constant rate. Internal volume when leakage at the UVA site started and at end of filling were measured, then used to calculate maximum internal pressure (Pmax) and pressure at leakage start (Pleak). Flow Fractionation (FF) was calculated by allowing free fluid flow through both UVA site and urethra onto separate, tared scales and recorded throughout the test. RACE scores were assigned by two blinded expert video reviewers. RESULTS: EXP showed higher Pmax, FF, and Pleak versus NOV (p=.0009; p=.005; p=.011) as well as EXP vs IM (p=.028; p=.047; p=.047), however IM vs NOV lacked significance. Multivariate analysis found significant positive correlations between Knot Tying (KT), Suture Placement (SP) and Tissue Approximation (TA) with FF (p=.017; p=.051; p=.0007) and Pmax (p=0.01; p=.087; p=.0005). TA and KT had significant correlations with Pleak (p=.0027; p=.085) (Figure 1). CONCLUSIONS: The bladder pressure test and its parameters we have developed represent three objective metrics that can be used to assess the ability of a trainee to complete a UVA that would succeed in an intraoperative leak test. Stratification of test difficulty towards the upper end of the RACE score spectrum offers more granularity by which intermediates can assess performance vs experts. Source of Funding: n/a © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e956 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nathan Schuler More articles by this author Alexis Steinmetz More articles by this author Kit Yuen More articles by this author Lauren Shepard More articles by this author Tyler Holler More articles by this author Christopher Wanderling More articles by this author Ahmed Ghazi More articles by this author Expand All Advertisement PDF downloadLoading ...

Experts Collaboration Learning for Continual Multi-Modal Reasoning.

Multi-modal reasoning, which aims to capture logical and causal structures in visual content and associate them with cues from other modality inputs (e.g., texts) to perform various types of reasoning, is an important research topic in artificial intelligence (AI). Existing works for multi-modal reasoning mainly exploit offline learning, where the training samples of all types of reasoning tasks are assumed to be available at once. Here we focus on continual learning for multi-modal reasoning (i.e., continual multi-modal reasoning), where the model is required to continuously learn to solve novel types of multi-modal reasoning tasks in a lifelong fashion. Continual multi-modal reasoning is challenging since the model needs to be able to effectively learn various types of new reasoning tasks, meanwhile avoiding forgetting. Here we propose a novel brain-inspired exp erts [Formula: see text]llaboration network (Expo), which incorporates multiple learning blocks (experts). When encountering a new task, our network dynamically assembles and updates a set of task-specific experts that are most relevant to learning the current task, by either utilizing learned experts or exploring new experts. This thus enables effective learning of new tasks, and meanwhile consolidates previously learned reasoning skills. Moreover, to automatically find optimal task-specific experts, an effective experts selection strategy is designed. Extensive experiments demonstrate the efficacy of our model for continual multi-modal reasoning.

The effects of social media attributes on customer purchase intention: The mediation role of brand attitude

Social media influencers have proved to be a major influence on customers’ purchasing decisions, especially with the increased usage of social media platforms. Social media influencers provide many opportunities for companies to increase their customer base and sales, and to enhance the attitude towards a brand. Despite the advantages of utilizing social media influencers, there are factors that social influencers need to take into consideration in order to engage customers and influence their decisions to purchase. The purpose of this study is to examine the factors that influence customers’ intention to purchase based on social media influencers. An online questionnaire was used to collect data from 439 Instagram platform users. A partial least square-SEM (PLS-SEM) approach was used to analyze and examine the proposed model. The results indicate that all constructs, namely Information Quality (IQ), Trustworthiness (TRU), Attractiveness (ATT), Meaning Transfer (TRA) and Expertise (EXP) significantly influence customers’ purchase intentions. This finding could provide insights for companies’ decision-makers when it comes to promoting their brands and increasing their sales. In addition, it could provide insights for social media influencers in terms of recognizing the important factors that encourage customers to engage and purchase.

Evaluación de la interfaz ciencia-política a nivel municipal en la implementación de la Agenda Local 21en Michoacán (México).

This work evaluated the Science-Policy Interface (SPI) promoted by the political instrument Agenda Local 21 in its Mexican version (called Agenda Desde lo Local) which articulated state officials (SO), municipal officials (MO), and academic experts (EX) on local management for sustainable development and were implemented in Michoacan (Mexico) between 2008 and 2013. The evaluation was conducted through a conceptual framework with four analytical categories spanning 16 factors and 39 attributes. Among the systemic factors, the objectives and processes of the interface showed strength, but the outputs had uncertain impacts. The attitudinal factors of involved actors showed high cognitive distance and very differentiated levels of reality between MO and EX. The motivation, commitment, and perception of the others were excellent in so, but the remaining actors showed weak performance. The evaluation led to lessons learned of interest in the design of political instruments that promote the links between science and policy.

Building a teacher training program that mimics novice scientists’ expertization for improving science teachers’ research capacity

Building a teacher training program that mimics novice scientists’ expertization for improving science teachers’ research capacity

Control-flow analysis of procedural skills competencies in medical training through process mining

BackgroundProcedural skills are key to good clinical results, and training in them involves a significant amount of resources. Control-flow analysis (ie, the order in which a process is performed) can...

Visual dependency and postural control on swing performance in golf players

Individuals have to reweight the respective contribution of the different sources of sensorial information for regulating posture and balance, especially during fine task execution. Given the evidences indicating strategy during swing performance as associated with prioritization of task-relevant visuospatial information for skill execution, the aim of the present work is to assess differences in visual dependency (VD) and postural control in a population of expert (EXP) and non-expert (NEXP) golfers when compared with healthy subjects (HC) and to discover possible relationships between these outcomes and swing performance. Thus, 15 golfers (EXP = 7; NEXP = 8) and 32 matched HC underwent otoneurological testing including video Head Impulse Test, posturography and Rod and Disk Test (RDT). Golf players also underwent a swing session procedure, which performance was measured by means of the Flightscope X2 Doppler-radar launch monitor system. EXP subjects demonstrated significant (p < 0.05) lower values in i) counter-clockwise (CCW) and clockwise (CW) dynamic conditions when compared with both NEXP and HC subjects RDT outcome measures and ii) surface and length posturography values as compared with HC subjects. When treating golf players outcomes as ‘a continuum’, CCW and CW scores were found to positively correlate with both lateral distance and horizontal launch angle and to negatively correlate with spin rpm. In conclusion, the present study suggests that the high-level of visual-independency demonstrated by EXP subjects may be functionally related in expert golfers to an effective motor strategy preferentially not referring to an inappropriate reliance on visual input.

Designing an innovative warning system to support risk-based meat inspection in poultry slaughterhouses

Historically and legally, meat inspection at slaughterhouses aims to ensure public health. Considering the sanitary, technical and regulatory developments, and given the growing societal concerns regarding animal welfare meat inspection has to be rethought based on a risk analysis to reach this objective. In this paper, we propose an innovative risk-based approach for poultry meat inspection based on a two-level warning system.In order to meet the objectives of health inspections of animals and animal products, four inspection tasks in slaughterhouses were identified: (1) analysis of Food Chain Information, (2) ante mortem examination, (3) post mortem examination and (4) feedback information. For each health inspection task, a set of food safety, animal health and welfare criteria and warning values were determined on the basis of the opinion of a multidisciplinary expert group and regulations. In this system, observers (OBSs) are responsible for implementing the first level of control by checking all the criteria previously determined. In the event of a warning value for a criterion during the examination, OBSs must alert the experts (EXPs), triggering a request for an expert opinion. After receiving an alert, veterinary health and meat safety EXPs intervene at the second level by taking over the batch and implementing appropriate measures depending on the type of warning criterion involved. The respective skills and missions of OBSs and EXPs have been defined to each verification level by dividing up tasks, duration and actions. To ensure the implementation and traceability of the two-level control system, the values observed for each criterion and actions undertaken by OBSs and EXPs have to be recorded for all batches, either paper-based and/or computer-based. To ensure harmonised procedures, the OBSs must undergo national training sessions on ante and post mortem examinations. In addition, to maintain and improve the quality of this first level of the verification process, EXPs may carry out random checks to verify that OBSs are correctly verifying all stages of the slaughter process and correctly detect warning criteria. In case of abnormality, EXPs may send a non-conformity sheet and request corrective measures.This study presents the first warning system applied to meat inspection in poultry slaughterhouses. Our comprehensive work was carried out with the support of a multidisciplinary group of experts, making it possible to formalise an efficient warning system. The next step has been to test this warning system in field conditions, on a sample of French slaughterhouses.

The adaptation to standing long jump distance in parkour is performed by the modulation of specific variables prior and during take-off

The present study aimed at investigating different variables that can be manipulated prior to and during take-off, to execute a specific standing long jump (SLJ) distance, according to jump expertise in parkour practitioners (= traceurs). Fourteen healthy young traceurs were included and separated into two groups: beginners (BEG) and experts (EXP). Firstly, classical vertical jump battery was used to characterize participants arm use and leg efficiency. Secondly, standing long jump (SLJ) performances were analyzed at four distances: 70, 80, 90, and 100% of each participant’s maximal SLJ distance. The force-time curves of the ground reaction forces (GRF) and the center of pressure (CoP) trajectory were measured with a force platform during the jump impulses. Take-off speed, angle and jump trajectory were estimated. For all of the participants, take-off speed and angle, power output, and vertical GRF during jump preparation (counter movement) varied with distance. The EXP group exhibited greater backward CoP excursion, greater arm participation, greater take-off velocity and a greater modulation of take-off angle than BEG group. When comparing jumps of similar distance, EXP exhibited a more curvilinear trajectory with a higher peak than BEG. To conclude, different motor strategies can be adopted based on the jump distance, and these strategies can evolve as parkour experience increases.

Expert opinion on advanced techniques for hemostasis in liver surgery

BackgroundReduction of perioperative blood loss and intraoperative transfusion are two major factors associated with improving outcomes in liver surgery. There is currently no consensus as to the best technique to achieve this. MethodsAn international Panel of Experts (EP), made up of hepatobiliary surgeons from well-known high-volume centres was assembled to share their experience with regard to the management of blood loss during liver resection surgery. The process included: a review of the current literature by the panel, a face-to-face meeting and an on-line survey completed by the EP prior to and following the face-to-face meeting, based on predetermined case scenarios. During the meeting the most frequently researched surgical techniques were appraised by the EP in terms of intraoperative blood loss. ResultsAll EP members agreed that high quality research on the subject was lacking. Following an agreed risk stratification algorithm, the EP concurred with the existing research that a haemostatic device should always be used along with any user preferred surgical instrumentation in both open and laparoscopic liver resection procedures, independently from stratification of bleeding risk. The combined use of Ultrasonic Dissector (UD) and saline-coupled bipolar sealing device (Aquamantys®) was the EP preferred technique for both open and laparoscopic surgery. ConclusionsThis EP propose the use of a bipolar sealer and UD for the best resection technique and essential equipment to minimise blood loss during liver surgery, stratified according to transfusion risk, in both open and laparoscopic liver resection.

Mission Critical 공공 정보화 구축 시험평가 개선 지표 연구

Up until recently, Korea has ranked the first place in UN e-Government Survey for three consecutive years. In keeping with such accomplishment, the size of budget execution has been consistently growing in accordance with Korea's Government 3.0 policy and vision, leading to increase in big-sized informatization projects in the business. Especially in mission critical public sector's infrastructure where it affects many people, growing demand for establishing high-quality information system with new technologies being brought to attention in order to meet the complex needs of citizens. National defense information system, being one of representative domains examples in the concerned area, established high military competency by applying breakthrough technology. Network-oriented national defense knowledge informatization was set as the vision in order to implement core roles in making efficient national defense management; and effort has been made to materialize the vision by making advancement in national defense's information system and its informatization implementation system. This research studies new quality index relevant to test and evaluation (T&E)of informatization business in national defense which is the representative example of mission critical public sector's infrastructure. We studied international standards and guidelines, analyzed actual T&E cases, and applied them to the inspection items that are currently in use, complying with the e-government law (Act No. 12346, Official Announcement Date 2014. 1.28., Enforcement Date 2014. 7.29.) As a result of productivity analysis, based on hypothesis in which suggested model was applied to T&E of the national defense informatization business, we confirmed the possibility of enhancement in the T&E productivity by assessing reliability, expert ise, and safety as evaluation factors.

Analysis Of The Heart Rate Responses Between Two Different Wii Sports Resort Canoeing Exercise Sessions

Much research has been conducted using interactive video games (ie. exergames) as a potential exercise mode. Nintendo Wii Sports Resort Canoeing (WSRC) is an exergame that has been assessed with results suggesting that playing 30 min of WSRC provided a moderate to vigorous aerobic response in above averagely fit subjects when played using the intermediate difficulty level. However, only two WSRC studies have been reported and assessing the aerobic response when playing the game at the expert difficulty level has not occurred. Thus, there is a need to evaluate WSRC exercise protocols using the expert difficulty level to determine if a higher heart rate response (HRR) could occur leading to a better aerobic workout. PURPOSE: To evaluate potential HRR differences between WSRC exercise sessions at the intermediate (INT) versus expert (EXP) levels and also to determine if playing WSRC at the EXP level yields a HRR that meets the ACSM guidelines for moderate physical activity (ie. HR intensity of 64-76.99% of HRmax). METHODS: Thirty above averagely fit college students (19 males and 11 females) participated in a maximal treadmill GXT to measure maximum heart rate (HRmax). Subjects then completed a 30 min WSRC exercise session at the INT or EXP level 72-96 hrs later. INT and EXP exercise sessions were separated by 72 hrs and completed in a counterbalanced order. Mean HRR and session RPE for INT and EXP were analyzed using Paired-Samples t-Tests with significant differences occurring at p < 0.05. Mean HRR of INT and EXP exercise sessions were also expressed as a percentage of HRmax. RESULTS: INT (135.5 +/- 17.6 bpm) and EXP (132.3 +/- 17.8 bpm) mean HRR were not significantly different (p = 0.09). Session RPE for INT (10.6 +/- 2.2) was also not significantly different (p = 0.17) versus EXP (10.3 +/- 2.1). CONCLUSION: Despite no significant differences occurring for the mean HRR, both INT (70.3 +/- 8.9% of HRmax) and EXP (68.8 +/- 8.3% of HRmax) met the ACSM moderate intensity guidelines suggesting that playing 30 min of Nintendo WSRC using an exercise protocol at the intermediate or expert level provides at least a moderate aerobic response in above averagely fit individuals. Further research should seek to determine if changing the WSRC exergame difficulty level from intermediate to beginner may contribute to a similar aerobic training session.

A prospective, randomised, clinical study to compare the use of McGrath(®), Truview(®) and Macintosh laryngoscopes for endotracheal intubation by novice and experienced Anaesthesiologists.

Background and Aims:Video laryngoscopy has been recommended as an alternative during difficult conventional direct laryngoscopy using the Macintosh blade (MAC). However, successful visualisation of the larynx and tracheal intubation using some of the indirect laryngoscopes or video laryngoscopes (VL) requires hand-eye coordination. We conducted this study to determine whether non-channel VLs are easy to use for novices and whether there is any association between expertise with MAC and ease of tracheal intubation with VLs.Methods:Anaesthesiologists participating in the study were divided into three groups: Group novice to intubation (NTI), Group novice to videoscope (NVL)- experienced with MAC, novice to VLs and Group expert (EXP) experienced in all. Group NTI, NVL received prior mannequin training. VLs- Truview® and McGrath series 5 (MGR) were compared with MAC. One hundred and twenty six adult patients with normal airway were randomised to both, the intubating anaesthesiologist and laryngoscope. The time taken to intubate (TTI) and participants’ rating of the ease of use was recorded on a scale of 1–10 (10-most difficult).Results:In Group NTI, there was no difference in mean TTI with the three scopes (P = 0.938). In Group NVL, TTI was longer with the VLs than MAC (P < 0.001). In Group EXP, TTI with VL took 20 s more (P < 0.001). There was significant difference in participants’ rating of ease of use of laryngoscope in Group NVL (P = 0.001) but not in the NTI (P = 0.205), EXP (P = 0.529) groups. A high failure was seen with MGR in Group NTI and NVL.Conclusion:In Group NTI, TTI and the ease of use were similar for all scopes. Expertise with standard direct laryngoscopy does not translate to expertise with VLs. Separate training and experience with VLs is required.

Recent Directions in Telemedicine: Review of Trends in Research and Practice.

ObjectivesHealthcare is now routinely delivered by telecommunications-based services in all developed countries and an increasing number of developing countries. Telemedicine is used in many clinical specialities and across numerous healthcare settings, which range from mobile patient-centric applications to complex interactions amongst clinicians in tertiary referral hospital settings. This paper discusses some recent areas of significant development and progress in the field with the purpose of identifying strong trends in both research and practice activities.MethodsTo establish the breadth of new ideas and directions in the field, a review of literature was made by searching PubMed for recent publications including terms (telemedicine OR telehealth) AND (challenge OR direction OR innovation OR new OR novel OR trend), for all searchable categories. 3,433 publications were identified that have appeared since January 1, 2005 (2,172 of these since January 1, 2010), based on a search conducted on June 1, 2015.ResultsThe current interest areas in these papers span both synchronous telemedicine, including intensive care, emergency medicine, and mental health, and asynchronous telemedicine, including wound and burns care, dermatology and ophthalmology.ConclusionsIt is concluded that two major drivers of contemporary tele medicine development are a high volume demand for a particular clinical service, and/or a high criticality of need for clinical exper tise to deliver the service. These areas offer promise for further study and enhancement of applicable telemedicine methods and have the potential for large-scale deployments internationally, which would contribute significantly to the advancement of healthcare.

Between ‘true believers’ and operational experts: UNESCO architects and school building in post-colonial Africa

Following decolonisation in the late 1950s, Cold War competitiveness and economic globalisation prompted old and new foreign powers to invest in the development of Africa. By means of building and urban planning, they sought to transmit their specific models of modernisation to the continent. Architects from divergent contexts and backgrounds embraced this opportunity to transfer their expertise to Africa, in particular through development aid organisations. This paper will shed light on the expert(ise)s that were exported to, and generated within, Africa in the 1960s and 1970s through one particular international aid agency, namely UNESCO. The focus will be on the organisation's activity in the field of school building, a crucial sector of development in Africa following the independence of former colonies across the continent. Through this agency, a transnational network of expert-architects with highly divergent backgrounds was generated. Taking UNESCO as a starting point, we identify a number of such globally operating architects who had a crucial impact on the design and construction of educational facilities, but remain unstudied to date. By an analysis of their work the paper reveals the design knowledge that was generated and the building expertise that circulated through UNESCO in Africa, while simultaneously untangling the complex networks and mechanisms behind this unique architecture production.

The Barcelona Knowledge Hub of the Academia Europaea

The Barcelona Knowledge Hub, a hub of the Academia Europaea, was set up in Barcelona in 2012 as the office for the Southern European region and the Mediterranean. The Academia Europaea is a pan-European, nongovernmental, not-for-profit association of over 3000 individual scientists and scholars who are recognised as experts and leaders in their own fi elds. It is commitied to identifying topics of trans-European importance to science and scholarship, and provides, where appropriate, its exper tise and its independent and impartial advice to European institutions, governments and international agencies concerning matters affecting science, scholarship and academic life in Europe. The Barcelona Knowledge Hub organises multidisciplinary ativities that consider the perspective of the social sciences and the humanities, with scholarly aims as well as the goal of promoting the dissemination of science.

EMC MODEL FOR MODERN POWER ELECTRONIC SYSTEMS FOR HARMONICS, LOSSES &amp; EMI ELIMINATION AND POWER QUALITY IMPROVEMENT

Electromagnetic compatibility of power electronic sbecomes an engineering discipline and it sho uld be considered at the beginning stage of a design. Thus, a power electron ics design becomes more complex and challenging and it requires a good communication between EMI and Power electronics exp erts. Three major issues in designing a power elect ronic system are Losses, EMI and Harmonics. These issues affect system cost, size, efficiency and quality and it is a tradeoff between these factors when we design a power converter, filter. In this paper the EMC model is discussed which should be considered while designing the power electronics systems. The design considerations in t his paper help us to remove losses, harmonics & EMI elimination and power quality improvement of Power systems.

Reflexão sobre a legitimidade da autonomia da enfermagem no campo das profissões de saúde à luz das ideias de Eliot Freidson

O estudo teve o objetivo de refletir acerca da Enfermagem como profissão da saúde à luz da teorização de Eliot Freidson para as profissões. Abordaram-se as credenciais para uma ocupação ser reconhecida como profissão, relacionando-as com as características da enfermagem, especialmente no Brasil. Na abordagem freidsoniana destacam-se como credenciais de profissão a expertise, a autonomia e a autorregulação. A enfermagem é analisada enfatizando a sua responsabilidade por uma gama de fazeres realizados com base em conhecimentos científicos, a necessidade de formação específica para o exercício da profissão, a disponibilidade de saberes e o reconhecimento do Estado do credenciamento formal de proteção aos membros da profissão. Conclui-se que a enfermagem é uma profissão da saúde, com papel fundamental para a transformação da realidade da saúde e que necessita investir no convencimento da sociedade acerca de sua utilidade enquanto profissão voltada às necessidades de saúde das pessoas.

Outcomes after laparoscopic living donor nephrectomy: comparison of two laparoscopic surgeons with different levels of expertise

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.