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ABSTRACT: Purpose:: For proper indications at university hospitals laparoscopic nephrectomy is often considered the standard of care. At community hospitals past surveys have not demonstrated this change. We describe the changing practice patterns of performing laparoscopic nephrectomies in indicated patients at our community hospital. We reviewed our data on monitoring our training program. Materials and Methods:: A retrospective chart review was performed of 381 consecutive complete nephrectomies performed at our institution from February 2000 to December 2003, including 62 live donor nephrectomies. Patient age, pathological size, operative time, estimated blood loss, duration to solid food intake and duration of hospitalization were compared between open nephrectomy and laparoscopic nephrectomy groups using the Wilcoxon 2-sample test. Surgical practice and surgeon characteristics were also described. Results:: Patients who underwent laparoscopic nephrectomy demonstrated superior postoperative recovery with earlier return to solid diet and shorter hospitalization. The 2 groups were similar in regard to major complication rates. The number of laparoscopic nephrectomies increased annually, while the number of open nephrectomies decreased. The number of laparoscopic urologists increased annually. More importantly laparoscopic urologists performed an increasing number of nephrectomies, while nonlaparoscopic urologists faced a decrease in the number of nephrectomies performed. There appeared to be little evidence of hand assisted laparoscopic nephrectomy as a bridge to learning standard laparoscopic nephrectomy. Conclusions:: Our training paradigm has safely and effectively trained community urologists to perform laparoscopic nephrectomies. Laparoscopic nephrectomy is now considered a standard treatment option along with conventional open surgery and it should be offered to the patient in the medical setting. Although fellowship trained urologists can certainly add expertise to any program, community based hospitals do not have to depend on them. [Copyright &y& Elsevier]

The coronavirus disease 2019 (COVID-19) pandemic imposed severe restrictions on traditional methods of patient care. During the pandemic, the heart failure program at New York-Presbyterian Hospital in New York, NY rapidly and comprehensively transitioned its care delivery model and administrative organization to conform to a new healthcare environment while still providing high-quality care to a large cohort of patients with heart failure, heart transplantation, and left ventricular assist device. In addition to the widespread adoption of telehealth, our program restructured outpatient care, initiating a shared clinic model and introducing a comprehensive remote monitoring program to manage patients with heart failure and heart transplant. All conferences, including administrative meetings, support groups, and educational seminars were converted to teleconferencing platforms. Following the peak of COVID-19, many of the new changes have been maintained, and the program structure will be permanently altered as a lasting effect of this pandemic. In this article, we review the details of our program's transition in the face of COVID-19 and highlight the programmatic changes that will endure. [ABSTRACT FROM AUTHOR]