title: Five-year experience of adoption and evolution of laparoscopic living donor nephrectomy: results from a center without large volume of patients.
abstract: OBJECTIVE
  Despite the advantages of laparoscopic living donor nephrectomy (LDN), this technique is known to have a steep learning curve that makes worldwide adoption challenging, especially in institutions without a large patients volume. Herein, we have reviewed our 5-year experience of adoption and evolution of this surgical technique, examining the donor and recipient outcomes.
  
  
  METHODS
  Between September 2002 and June 2007, 40 LDNs were performed consecutively. Our surgical technique was mainly derived from the University of California San Francisco method. We retrospectively reviewed the donor demographics, operative characteristics, perioperative complication of donors/recipients, and outcomes of donors and recipients.
  
  
  RESULTS
  Among the 40 cases, 36 (90.0%) were left-sided LDNs. Mean operative time was 335.1 +/- 66.9 minutes, blood loss was 303.9 +/- 333.2 mL, and warm ischemia time was 243.2 +/- 127.0 seconds. Multiple renal arteries required bench arterial reconstruction in 7 (17.5%) donor kidneys. Three renovascular injuries occurred intraoperatively, and 2 (5.0%) required open conversion. The overall postoperative complication rate was 20.0%. Postoperative donor serum creatinine was 1.5 times higher than preoperative serum creatinine. All but one recipient was discharged with adequate renal function. Graft function continues in 36 of the 38 harvested kidneys (94.7%) during the follow-up period. One (2.5%) recipient developed ureteral necrosis, and no recipients developed vascular thrombosis.
  
  
  CONCLUSIONS
  LDNs can be performed with careful adoption and evolution in institutions without a large patient volume. The intraoperative complication rate of LDN can be reduced with experience.
authors.affiliation: Division of Transplantation, Department of Surgery, National Cheng-Kung University Hospital, Tainan, Taiwan.
authors.forename: C J
authors.initials: CJ
authors.lastname: Hung
authors.forename: Y J
authors.initials: YJ
authors.lastname: Lin
authors.forename: S S
authors.initials: SS
authors.lastname: Chang
authors.forename: T C
authors.initials: TC
authors.lastname: Chou
authors.forename: J P
authors.initials: JP
authors.lastname: Chuang
authors.forename: P Y
authors.initials: PY
authors.lastname: Chung
authors.forename: Y S
authors.initials: YS
authors.lastname: Lin
authors.forename: P C
authors.initials: PC
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000502:physiology*; D010535:Laparoscopy / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies; D013624:Taiwan; D016896:Treatment Outcome
chemical_list: D003404:Creatinine