Learning laparoscopic donor nephrectomy safely: a report on 100 cases.
OBJECTIVE
There is concern that learning laparoscopic live donor nephrectomy (LLDN) is associated with increased morbidity. We propose that with a team approach LLDN can be learned safely, without increased donor morbidity or graft failure, even during the early portion of a learning curve.


METHODS
Case series with cohort comparison.


METHODS
Tertiary referral center.


METHODS
The laparoscopic group consisted of 100 donors and 100 recipients; the open group, 50 donors and 50 recipients.


METHODS
A team approach that combines laparoscopic and urologic expertise was used to perform 100 cases of LLDN.


METHODS
Donor morbidity and graft function in the laparoscopic group were compared with those in the open group.


RESULTS
Laparoscopic live donor nephrectomy was completed in 99 patients. One patient required conversion to open donor nephrectomy because of intraoperative hemorrhage. Minor complications occurred in 6 laparoscopic group donors (6%) and 3 open group donors (6%). Laparoscopic and open group donors were of similar age. Operative times were longer for laparoscopic group donors (231 vs 209 minutes). Mean hospital stay was shorter for laparoscopic group donors (3.3 vs 4.7 days). Graft function was comparable between the laparoscopic and open groups, with equivalent postoperative creatinine levels. Graft survival was comparable. Recipient ureteral complications occurred with less frequency (2% vs 6%) in the laparoscopic group.


CONCLUSIONS
By forming an operative team that combines expertise in laparoscopy with expertise in live donor nephrectomy, surgeons can learn LLDN safely. Adoption of the techniques developed by those who pioneered the procedure can further minimize the morbidity associated with a learning curve.
Rawlins
Mathew C
MC
Section of General, Vascular, and Thoracic Surgery, Department of Surgery, Virginia Mason Medical Center, 1100 Ninth Ave, C6-Gsurg, PO Box 900, Seattle, WA 98111, USA. gtstrb@vmmc.org
Hefty
Thomas L
TL
Brown
Scott L
SL
Biehl
Thomas R
TR
D000328:Adult; D015331:Cohort Studies; D005260:Female; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D019520:Living Donors; D008297:Male; D009017:Morbidity; D009392:Nephrectomy / Q000193:education / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control