Laparoscopic donor nephrectomy: effects of learning curve on surgical outcomes

Our objective was to determine the effect of an experienced laparoscopic surgeon's learning curve with laparoscopic donor nephrectomy (LDN) on patient outcome and graft function.

Retrospective review of the medical records of the initial 73 consecutive LDN patients and corresponding transplant recipients was performed. All of the LDN were performed by a single, experienced laparoscopic surgeon (C.P.S.). The method of LDN was slightly different between the groups.

Patients were divided into early and late groups with 37 and 36 patients, respectively. There was no statistically significant difference in mean estimated blood loss (245 +/- 671.2 vs 84.7 +/- 63.9 mL), warm ischemia time (159.7 +/- 66.3 vs 150.8 +/- 63.0 seconds), postoperative creatinine levels (1.34 +/- 0.24 vs 1.29 +/- 0.26 mg/dL,), recipient mean creatinine level at 1 month (1.57 +/- .98 vs 1.53 +/- 0.46 mg/dL), and hospital stay (2.49 +/- 0.87 vs 2.47 +/- 0.56 days) between the early and late groups. However, the difference in mean operative time between early and late groups was statistically significant (255.2 +/- 42.4 vs. 209.1 +/- 30.8 minutes, P < .05). In addition, there were 8 (21.6%) vs 4 (11.1%) instances of slow graft function and 3 (8.1%) vs 0 instances of delayed graft function among the recipients in early group versus the late group. There were four (10.8%) vs two (5.6%) minor complications among donors of the early and late groups, respectively.

There is a significant decrease in operating time and incidence of delayed graft function following the first 37 patients who underwent LDN by an experienced laparoscopist. Improvement in operative technique decreased operative time and improved perioperative graft function as evidenced by decreased slow graft function and delayed graft function in the late group.