Abstract
We developed a preoperative assessment system to predict surgical workload in hand-assisted laparoscopic donor nephrectomy (HALDNx) using the normal-based linear discriminant rule (NLDR). A total of 128 cases of left HALDNx performed by a single operator were used as training data. Surgical workload was measured by operative time. The optimized model had 9 explanatory variables: age, total protein, total cholesterol, number of renal arteries (numberRA), 4 variables of perinephric fat (PNF), and thickness of subcutaneous fat. This model was validated using cross-validation and the .632 estimator to estimate discrimination rates with future test data. PNF and numberRA were the predominant factors affecting workload followed by the computed tomography value of PNF, body weight, and male sex. The estimated accuracy of the prediction system was 94.6%. The complication rate was 9.38% and did not correlate with surgical workload. We also made our program available online for constructing assessment functions from other cohort data. In conclusion, the surgical workload of HALDNx could be predicted with PNF and numberRA as the dominant risk factors.
Highlights
Laparoscopic nephrectomy was first introduced by Clayman et al [1] in 1991
We describe a preoperative system for evaluation of surgical workload in HALDNx to demonstrate the possibility of calibrating operative difficulty using a discrimination index formulated for each donor and predicting whether HALDNx is expected to be time-consuming
Univariate linear regression revealed that male sex, body weight (Bw), height (Ht), triglyceride (TG) level, numberRA of the graft, maximum and median thicknesses of medial perinephric fat, median thickness of lateral perinephric fat, area of perinephric fat, computed tomography (CT) value of perinephric fat density, and area of subcutaneous fat were all significantly correlated with operative time
Summary
Laparoscopic nephrectomy was first introduced by Clayman et al [1] in 1991. The first successes in standard laparoscopic live donor nephrectomy by Ratner and Kavoussi [2] in 1995 and in hand-assisted laparoscopic donor nephrectomy (HALDNx) by Wolf [3] in 1998 have proven the minimal invasiveness of these procedures compared with open donor nephrectomy, including lower morbidity, shorter hospitalization, and rapid convalescence [4,5,6,7,8]. We used donors’ demographic and laboratory data in addition to imaging information from abdominal computed tomography (CT) scans to collect independent variables for predictive discriminant analysis (PDA) of surgical workload. Such a preoperative evaluation system might enable the selection of an appropriate laparoscopic surgeon for a donor based on the predicted surgical workload, and the development of a strategy for a novice laparoscopist to pass through the learning curve safely by selecting donors with lower expected surgical workload. We describe a preoperative system for evaluation of surgical workload in HALDNx to demonstrate the possibility of calibrating operative difficulty using a discrimination index formulated for each donor and predicting whether HALDNx is expected to be time-consuming
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