A new swine training model of hand-assisted donor nephrectomy.
BACKGROUND
Despite the described advantages of hand-assisted laparoscopic donor nephrectomy (HALDN), the learning curve risks discourage many transplant centers to switch from the traditional technique to the laparoscopic approach. Considering that the learning curve risk may be softened with practice on a training model the aim of this study was examine a low-cost, high-fidelity model of HALDN in pigs.


METHODS
Ten female white pigs underwent a left and then a right HALDN in the same session for a total of 20 procedures. For each nephrectomy, we assessed operative times and intraoperative complications. All nephrectomies were performed by a single senior transplantation surgeon.


RESULTS
All animals that survived bilateral nephrectomy were sacrificed. Two right HALDNs were converted to open procedures due to bleeding. One spleen lesion and one lumbar vein injury were treated laparoscopically. Considering only the 18 HALDN completed, we registered a mean total operative time of 75.4 min (range=52 to 120).


CONCLUSIONS
The in vivo training model described herein made it possible to reproduce the positions and operative difficulties similar to those encountered in clinical practice. Moreover, the costs can be considerably reduced by performing two procedures in each animal employing reusable instruments. Our model represented a valid high-fidelity training procedure that was useful and convenient to achieve skills for HALDN that may help transplantation centers adopt this technique to reduce the learning curve risk.
Cavallari
G
G
Department of Surgery, Intensive Care and Transplantation, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. giuseppe.cavallari3@unibo.it
Tsivian
M
M
Bertelli
R
R
Neri
F
F
Faenza
A
A
Nardo
B
B
D000818:Animals; D006225:Hand; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000662:veterinary; D023421:Models, Animal; D009392:Nephrectomy / Q000379:methods* / Q000662:veterinary; D013525:Surgical Instruments; D013514:Surgical Procedures, Operative; D013552:Swine