Learning curves of minimally invasive donor nephrectomy in a high-volume center: A cohort study of 1895 consecutive living donors

Kosei Takagi,Hendrikus J.A.N Kimenai,Turkan Terkivatan,Khe T.C Tran,Jan N.M Ijzermans,Robert C Minnee

doi:10.1016/j.ijsu.2020.12.011

Kosei Takagi, Hendrikus J.A.N Kimenai + Show 4 more

Open Access

https://doi.org/10.1016/j.ijsu.2020.12.011

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Abstract

BackgroundFew studies have investigated the learning curves of minimally invasive donor nephrectomy (MIDN) using the cumulative sum (CUSUM) analysis. In addition, no study has compared the learning curves of the different surgical MIDN techniques in one cohort study using the CUSUM analysis. This study aims to evaluate and compare learning curves for several MIDN using the CUSUM analysis. MethodsA retrospective review of consecutive donors, who underwent MIDN between 1997 and 2019, was conducted. Three laparoscopic-assisted techniques were applied in our institution and included for analysis: laparoscopic (LDN), hand-assisted retroperitoneoscopic (HARP), and robot-assisted laparoscopic (RADN) donor nephrectomy. The outcomes were compared based on surgeon volume to develop learning curves for the operative time per surgeon. ResultsOut of 1895 MIDN, 1365 (72.0%) were LDN, 427 (22.5%) were HARP, and 103 (5.4%) were RADN. The median operative time and median blood loss were 179 (IQR, 139–230) minutes and 100 (IQR, 40–200) mL, respectively. The incidence of major complication was 1.2% with no mortality, and the median hospital stay was three (IQR, 3–4) days. The CUSUM analysis resulted in learning curves, defined by decreased operative time, of 23 cases in LDN, 45 cases in HARP, and 26 cases in RADN. ConclusionsOur study shows different learning curves in three MIDN techniques with equal post-operative complications. The LDN and RADN learning curves are shorter than that of the hand-assisted donor nephrectomy. Our observations can be helpful for informing the development of teaching requirements for fellows to be trained in MIDN.

Highlights

Invasive donor nephrectomy (MIDN) has emerged as the standard technique for living donor kidney transplantation
Several techniques have been introduced as minimally invasive donor nephrectomy (MIDN), such as laparoscopic (LDN), hand-assisted retroperitoneoscopic (HARP), hand-assisted intraperitoneal, robot-assisted laparoscopic (RADN), and laparoendo scopic single-site donor nephrectomy [1]
The aim of this study is to investigate the effect of surgeon volume on outcomes in MIDN and to determine learning curves for MIDN using the cumulative sum (CUSUM) analysis in a high-volume center in Western Europe

Summary

Introduction

Invasive donor nephrectomy (MIDN) has emerged as the standard technique for living donor kidney transplantation. The cumulative sum (CUSUM) analysis, which is a useful tool for evaluating the learning curve for surgical procedures [5,6,7], has been adopted in minimally invasive surgery [8,9]. No study has compared the learning curves of different MIDN techniques in one cohort study using the CUSUM analysis. Few studies have investigated the learning curves of minimally invasive donor nephrectomy (MIDN) using the cumulative sum (CUSUM) analysis. No study has compared the learning curves of the different surgical MIDN techniques in one cohort study using the CUSUM analysis. The CUSUM analysis resulted in learning curves, defined by decreased operative time, of 23 cases in LDN, 45 cases in HARP, and 26 cases in RADN. Conclusions: Our study shows different learning curves in three MIDN techniques with equal post-operative complications.

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