Learning Curve in Laparoscopic Living Donor Nephrectomy

Abstract

To examine the learning curve of laparoscopic living donor nephrectomy (LLDN) in our institution. A retrospective review was performed for the initial 300 cases of laparoscopic living donor nephrectomy in Cipto Mangunkusumo Hospital from November 2011 to December 2015. The data was classified into three groups of 100 procedures. In the initial cases, the procedure was performed by one laparoscopic surgeon. After a series of cases, another laparoscopic surgeon began performing donor nephrectomy, followed by a third laparoscopic surgeon. Each procedure was performed by two laparoscopic surgeon. We evaluated 300 patients of laparoscopic living donor nephrectomy in our center and compared each group. The mean total operating time showed a significant decline in group 3 compared to group 1 (261.6±49 minutes vs. 239.7±36.4 minutes) (p = 0.001). The mean time to clip presented a decline in group 2 and 3 (172.5±44.1 minutes vs. 160.3±31.8 minutes vs. 146.4±34.7 minutes) (p < 0.05). The mean first warm ischemia times dropped from 6.3±3.6 minutes to 2.9±1.9 minutes to 2.0±0.6 minutes (p < 0.05). The median estimated intraoperative blood loss fell from 200 cc in group 1 to 100 cc in group 2 and 3 (p < 0.001). High volume of cases and direct mentoring system enhance the learning curve in LLDN procedure which was categorized as a very difficult procedure. The development of a successful laparoscopic live donor nephrectomy training programme can be achieved without significant detrimental effect to the patient provided the necessary steps are observed.