Laparoscopic Living Kidney Donation at a Single Center: An Examination of Donor Outcomes with Increasing Experience

Abstract

This study was undertaken to examine short-term outcomes of laparoscopic donor nephrectomy performed by transplant surgeons at a medium volume institution, with the specific goal of determining the presence of a learning curve effect. With institutional review board approval, a retrospective chart review was performed examining patient demographics, operative factors, and in-hospital outcomes over a 12-year period. Specific attention was paid to differences in outcomes between patients undergoing operation in the first versus the most recent 6-year period. Continuous and categorical variables were examined using the Wilcoxon rank sum test and χ2 analysis, respectively. The study group consisted of 129 patients. Median operative time was 234 minutes with a median estimated blood loss of 100. The median preoperative creatinine was 0.9, with a postoperative median creatinine of 1.3. The overall complication rate was 12.4 per cent, with ileus being the most common. There were two cases of post op acute renal failure, both of which were self limited and did not require dialysis. No patients died. Patients in the most recent 6 years (n = 77) enjoyed a shorter length of stay (2 vs 3 days, P < 0.001) than patients in the first 6-year period (n = 52). Additionally, there was a trend towards decreased complications in the second era that did not reach significance (9.1% vs 17.3%, P = 0.17). Laparoscopic donor nephrectomy is an attractive means of donation, and can be performed with low risk to the donor and minimal learning curve effect.

Outcomes and surgical complications following living‐donor renal transplantation using kidneys retrieved with trans‐peritoneal or retro‐peritoneal hand‐assisted laparoscopic nephrectomy

“…As previously observed by Buell and colleagues, 30 we noted that the vast majority of surgical complications including SSI and incisional hernia occurred in the early stages of our experience with both techniques; incisional hernia between 2009 and 2012 and SSI between 2011 and 2014. The opportunity of regular departmental audit and immediate feedback on the occurrence of such complications has allowed the implementation of relevant corrections and improvements in the surgical setting as well as donor peri‐operative antibiotic prophylaxis and wound care protocols.…”

“…Especially in medium‐sized centers like ours, it is easy suffering the perception of increased complications anytime we observed one. It certainly reflects the experience of a unit that can cope and adapt to rapidly increased case volumes with the inevitable, resultant numbers of complications 30,38 . Nevertheless, we found that urological complications rate remained low throughout the study period and comparable to other published series 39,40 .…”

“…Consistently maintaining cold ischemia time (CIT) below three hours has also undoubtedly played a role [35][36][37] This practice is shared by many transplant centers and reduces the inevitable stress on the mentored surgeon while maintaining the highest quality of the service without the effects of multiple learning curves. 30,38 Reported incidence of DGF after LDRT varies from 4% to 10%, depending on the series. 35 We noticed that DGF rate was higher after RP-HALDN than TP-HALDN (4.9% vs 1.3% Nevertheless, we found that urological complications rate remained low throughout the study period and comparable to other published series.…”

“…Furthermore, we have consistently ensured the attendance of two senior consultants during the most crucial parts of the procedure thus allowing the surgeon to remain focused on the critical steps of the operation. This practice is shared by many transplant centers and reduces the inevitable stress on the mentored surgeon while maintaining the highest quality of the service without the effects of multiple learning curves 30,38 . Reported incidence of DGF after LDRT varies from 4% to 10%, depending on the series 35 .…”

A novel difficulty grading system for laparoscopic living donor nephrectomy

“…Using the difficulty index of 0-8, indexes 0 and 8 were defined as the easiest and the most difficult case. Difficulty index was further categorized into three levels as the difficulty classification: low difficulty (0-2), intermediate difficulty (3)(4)(5), and high difficulty (6)(7)(8).…”