Retroperitoneoscopic living donor nephrectomy: short learning curve and our original hybrid technique

To evaluate the effect of the learning curve for the hybrid technique of retroperitoneoscopic living donor nephrectomy (RDN) on donor and recipient outcomes.

We retrospectively reviewed 120 consecutive patients who underwent RDN, performed by a laparoscopic surgeon, at Sendai Shakaihoken Hospital between May 2005 and September 2011. A new hybrid technique, in which 2 laparoscopic ports were inserted through a hand-port device and all the procedures except mobilization and taping of ureter and extracting kidney were performed with nonhand-assisted technique, was used. These 120 patients were classified into 4 groups (groups 1-4) of 30 patients each on the basis of the order in which they were operated on by the surgeon.

Baseline data including donors' age, gender, and body mass index did not differ among the groups. The time required for graft extraction and overall operative time were significantly longer in group 1 than in the other 3 groups. However, warm ischemia time, blood loss, length of postoperative hospital stay, and graft function did not differ among the groups.

These results indicate that the hybrid technique of RDN could be performed by surgeons with acceptable outcomes, in donors and recipients, even during the early stages of practicing RDN. Although the time required for graft extraction and overall operative time were much longer during the learning phase, the learning curve was short and improved rapidly after performing only 30 procedures.