title: Laparoscopic living kidney donation at a single center: an examination of donor outcomes with increasing experience.
abstract: This study was undertaken to examine short-term outcomes of laparoscopic donor nephrectomy performed by transplant surgeons at a medium volume institution, with the specific goal of determining the presence of a learning curve effect. With institutional review board approval, a retrospective  chart review was performed examining patient demographics, operative factors, and in-hospital outcomes over a 12-year period. Specific attention was paid to differences in outcomes between patients undergoing operation in the first versus the most recent 6-year period. Continuous and  categorical variables were examined using the Wilcoxon rank sum test and χ(2) analysis, respectively. The study group consisted of 129 patients. Median operative time was 234 minutes with a median estimated blood loss of 100. The median preoperative creatinine was 0.9, with a  postoperative median creatinine of 1.3. The overall complication rate was 12.4 per cent, with ileus being the most common. There were two cases of post op acute renal failure, both of which were self limited and did not require dialysis. No patients died. Patients in the most recent 6 years  (n = 77) enjoyed a shorter length of stay (2 vs 3 days, P < 0.001) than patients in the first 6-year period (n = 52). Additionally, there was a trend towards decreased complications in the second era that did not reach significance (9.1% vs 17.3%, P = 0.17).  Laparoscopic donor nephrectomy is an attractive means of donation, and can be performed with low risk to the donor and minimal learning curve effect.
authors.affiliation: Division of Transplantation, Department of Surgery, University of Louisville, Louisville, Kentucky, USA. Rmcann03@louisville.edu
authors.forename: Robert M
authors.initials: RM
authors.lastname: Cannon
authors.forename: Mary
authors.initials: M
authors.lastname: Eng
authors.forename: Michael R
authors.initials: MR
authors.lastname: Marvin
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Buell
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D010535:Laparoscopy; D059032:Learning Curve; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies; D055815:Young Adult