The learning curve for modified hand-assisted retroperitoneoscopic living donor nephrectomy

Area of Science:

• Urology
• Surgical Innovation
• Transplantation Surgery

Background:

• Living donor nephrectomy is crucial for kidney transplantation.
• Minimally invasive techniques aim to improve donor outcomes.
• The modified hand-assisted retroperitoneoscopic living donor nephrectomy (HARPLDN) technique is presented.

Purpose of the Study:

• To introduce a modified HARPLDN technique.
• To define the learning curve associated with this modified technique.
• To assess the safety and efficacy of the HARPLDN approach.

Main Methods:

• A cohort of 138 kidney donors underwent modified HARPLDN by a single surgeon.
• Data were collected between May 2015 and March 2022.
• Cumulative sum (CUSUM) learning curve analysis was performed using total operative time.

Main Results:

• The mean operative time was 138.2 ± 32.1 minutes.
• The CUSUM analysis identified three phases: initial learning (41 cases), competence (43 cases), and mastery (54 cases).
• High graft survival (99.3%) and immediate function (94.9%) were observed with minimal complications.

Conclusions:

• The modified HARPLDN technique is safe and effective for living donor nephrectomy.
• Advantages include shorter operating times and optimized warm ischemic time (WIT).
• Surgeons can achieve proficiency with the modified HARPLDN after 41 cases.