Evaluating the differences in the early laparoscopic donor nephrectomy learning curves of a Swiss high volume transplant program and a South African low volume transplant program after knowledge transfer

André Van Der Merwe,G Bonkat,H Van Deventer,Z Keyser,G Mantica,H Van Heerden,A Bachmann,N Nicole Ebinger Mundorf

doi:10.1186/s12301-021-00215-0

Abstract

BackgroundTo describe the retroperitoneoscopic donor nephrectomy learning curve differences between a high volume (training) hospital in Basel, Switzerland, and a low volume (trainee) hospital in Cape Town, South Africa, after knowledge transfer. The South African hospital is resource constraint in hospital and training equipment. Techniques for performing the surgery were near identical.MethodsBoth units maintained prospective databases. Comparisons were made of the first 74 cases in each database: Basel’s series were from 19 January 2001 until 28 June 2004, while the Cape Town Hospital were from 8 April 2008 until 15 July 2008. Four surgeons operated in the Basel group, while only one surgeon operated in the Cape Town group. Variables compared include operating time (first skin incision until kidney was extracted), warm ischaemic time (renal arterial occlusion until cold bench reperfusion), blood loss, graft function, and hospital stay. We also analysed the first and last 25 cases of each series. Subgroup analysis of a single Basel surgeon was conducted.ResultsDonor age (means: Basel vs. Cape Town 54 vs. 33 p < 0.0001) and gender (males vs. females Cape Town 57% male and Basel 31% male) differed widely. The Basel group did more left-sided operations (72% vs. 58%). Operative times, blood loss and donor creatinine did not differ. Warm ischaemic time was significantly shorter in the Basel group (Cape Town mean 204 s Basel mean 130 s P = 0.0023). There was double the number of early graft failures in the South African group (six vs. three)—not related to donor surgery. Both groups showed a decline in operating times, plateauing at 30–34 cases.ConclusionsThere are statistically significant differences in some aspects of the learning curves of the Swiss (training) and South African (trainee) hospitals. These differences are clinically not pronounced, and the knowledge transfer was worth the effort.

Highlights

To describe the retroperitoneoscopic donor nephrectomy learning curve differences between a high volume hospital in Basel, Switzerland, and a low volume hospital in Cape Town, South Africa, after knowledge transfer
Virtual trainers [3], dry laboratory trainers, or telementoring [4] might be successfully used to increase skill and decrease the learning curve prior to operating on patients. These tools are useful in the era of reduced working hours and increased litigation—they were not available in the South African unit at the time of starting the donor nephrectomy program
The use and evolution from porcine models to human patients for performing laparoscopic donor nephrectomy have been used with success to reduce operating time and blood loss [5, 6]

Summary

Introduction

To describe the retroperitoneoscopic donor nephrectomy learning curve differences between a high volume (training) hospital in Basel, Switzerland, and a low volume (trainee) hospital in Cape Town, South Africa, after knowledge transfer. The South African hospital studied (Tygerberg Academic Hospital, Cape Town) lacked some of the necessary skill and training infrastructure to start a laparoscopic donor program on site. Virtual trainers [3], dry laboratory trainers, or telementoring [4] might be successfully used to increase skill and decrease the learning curve prior to operating on patients. These tools are useful in the era of reduced working hours and increased litigation—they were not available in the South African unit at the time of starting the donor nephrectomy program. Donor safety at Tygerberg Hospital has been established after 50 cases [8]; more cases were evaluated to exclude potential bias at 50 patients

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Conclusion