Transition From Hand-Assisted to Pure Laparoscopic Donor Nephrectomy

Area of Science:

• Nephrology
• Minimally Invasive Surgery
• Transplant Surgery

Background:

• Comparing hand-assisted laparoscopic donor nephrectomy (HALDN) and pure laparoscopic donor nephrectomy (PLDN) outcomes.
• Assessing the feasibility of transitioning from HALDN to PLDN for surgeons with limited laparoscopic renal surgery experience.

Purpose of the Study:

• To evaluate perioperative donor outcomes and early graft function after transitioning from HALDN to PLDN.
• To determine if a surgeon inexperienced in laparoscopic renal surgery can safely adopt PLDN after performing HALDN.

Main Methods:

• A single surgeon performed 60 donor nephrectomies: 30 HALDN followed by 30 PLDN.
• Compared operative and convalescence parameters, and intra/postoperative complications (Satava and Clavien-Dindo classifications).
• Used binary logistic regression to identify predictors of complications.

Main Results:

• No significant differences in donor operative/convalescence parameters or graft outcomes between HALDN and PLDN.
• Similar rates of intraoperative (43.3% vs 36.7%) and postoperative (86.7% vs 70.0%) complications.
• Female sex and the learning curve were significant determinants of fewer postoperative complications.

Conclusions:

• The transition from HALDN to PLDN is technically feasible for surgeons new to laparoscopic renal surgery.
• This transition does not result in a steep learning curve.
• Perioperative donor and graft outcomes remain similar when switching from HALDN to PLDN.