Learning Curve for Laparoendoscopic Single-Incision Live Donor Nephrectomy: Implications for Laparoendoscopic...

Area of Science:

• Urology
• Minimally Invasive Surgery
• Transplant Surgery

Background:

• Laparoendoscopic single-incision live donor nephrectomy is technically more complex than conventional multiport approaches.
• The learning curve for this advanced surgical technique is not well-established.

Purpose of the Study:

• To analyze the learning curve associated with laparoendoscopic single-incision live donor nephrectomy.
• To evaluate donor and recipient outcomes during the learning phase and after proficiency is achieved.

Main Methods:

• Retrospective cohort study of 114 consecutive single-incision laparoendoscopic nephrectomies in live kidney donors.
• Cumulative sum (CUSUM) analysis of operating time to determine the learning curve.
• Comparison of outcomes between the learning phase (first 61 cases) and the post-learning phase (cases 62-114).

Main Results:

• The learning curve was achieved after case 61, with operating times significantly longer during the learning phase (p=0.05).
• Mean warm ischemic time was significantly longer in the learning phase (6 min vs 5 min, p=0.04).
• Conversion rates, donor complications, and recipient outcomes (delayed graft function, graft survival) were not significantly different between the two phases.

Conclusions:

• Single-incision laparoendoscopic donor nephrectomy demonstrates a substantial learning curve, requiring over 60 cases for proficiency.
• Excellent donor and recipient outcomes are achievable post-learning curve.
• Findings have significant implications for surgical programs transitioning to single-incision techniques and for developing training curricula for fellows.