title: Evolution of laparoscopic donor nephrectomy technique and outcomes: a single-center experience with more than 1300 cases.
abstract: OBJECTIVE
  To describe and illustrate the evolution of surgical technique, emphasizing technical modifications of laparoscopic donor nephrectomy (LDN) and the impact on complication outcome.
  
  
  METHODS
  This is a retrospective observational study of prospectively collected data on all consecutive purely LDN surgeries performed at a tertiary academic medical center (n = 1325), performed between March 2000 and October 2013.
  
  
  RESULTS
  Over time, LDN was performed on older patients, changing from a mean of 35.7 years in 2000 to 41.2 years in 2013 (P <.001). Additionally, mean blood loss decreased from 75 mL in 2000 to 21.6 mL in 2013 (P <.001). However, body mass index, operative time, and length of stay remained similar. Overall, there were 105 (7.9%) complications: Clavien grade 1 (n = 81, 6.1%) and grade 2 or higher (n = 23, 1.8%). Procedure duration, blood loss, surgeon, year of procedure, laterality, body mass index, age, and gender did not significantly predict complications. There was no significant difference for Clavien complication rates between the early learning period (first 150 cases) and the rest of the series.
  
  
  CONCLUSIONS
  With continual refinement with LDN techniques based on intraoperative observations and technological advances, complication rates remain consistently low, despite increasing donor age.
authors.affiliation: Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA. Electronic address: etreat@mednet.ucla.edu.
authors.forename: Eric G
authors.initials: EG
authors.lastname: Treat
authors.affiliation: Department of Urology, Yale School of Medicine, New Haven, CT.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Schulam
authors.affiliation: Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA.
authors.forename: Hans A
authors.initials: HA
authors.lastname: Gritsch
authors.affiliation: Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA.
authors.forename: Chia-Hung
authors.initials: CH
authors.lastname: Liu
authors.affiliation: Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA.
authors.forename: Siwei
authors.initials: S
authors.lastname: Xiong
authors.affiliation: Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA.
authors.forename: Felipe
authors.initials: F
authors.lastname: Passos
authors.affiliation: David Geffen School of Medicine at UCLA, Los Angeles, CA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Chuang
authors.affiliation: Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA.
authors.forename: Jim C
authors.initials: JC
authors.lastname: Hu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting; D055815:Young Adult