title: Transition From Hand-Assisted to Pure Laparoscopic Donor Nephrectomy.
abstract: OBJECTIVE
  We compared perioperative donor outcomes and early graft function of hand-assisted laparoscopic donor nephrectomy (HALDN) and pure laparoscopic donor nephrectomy (PLDN) performed by a single surgeon, to define the feasibility of technical transition from HALDN to PLDN.
  
  
  METHODS
  From October 1, 2012, through June 30, 2014, 60 donor nephrectomies were performed by a single surgeon who lacked experience with laparoscopic renal surgery: the first 30 by HALDN and the last 30 by PLDN. Operative and convalescence parameters were compared, as were intra- and postoperative complications within 90 days according to the Satava and Clavien-Dindo classifications, respectively. Binary logistic regression analysis was used to estimate the association of baseline characteristics with complications.
  
  
  RESULTS
  Baseline characteristics were similar in the 2 groups, except for American Society of Anesthesiologists score II (10.0% vs 43.3%; P = .007). All procedures were completed as planned. All operative and convalescence parameters of donors and graft outcomes were similar in the 2 groups, as were overall rates of intraoperative (43.3% vs 36.7%, P = .598) and postoperative (86.7% vs 70.0%; P = .209) complications. No factor was significantly predictive of intraoperative complications, whereas sex (female vs male, odds ratio, 0.183; P = .029) and learning curve (odds ratio, 0.602; P = .036) were significant determinants of postoperative complication.
  
  
  CONCLUSIONS
  The technical transition from HALDN to PLDN does not involve a steep learning curve for surgeons less experienced with laparoscopic renal surgery and maintains similar perioperative donor and graft outcomes.
authors.affiliation: Departments of Urology.
authors.forename: Dalsan
authors.initials: D
authors.lastname: You
authors.affiliation: Departments of Urology.
authors.forename: Chunwoo
authors.initials: C
authors.lastname: Lee
authors.affiliation: Departments of Urology.
authors.forename: In Gab
authors.initials: IG
authors.lastname: Jeong
authors.affiliation: Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Duck Jong
authors.initials: DJ
authors.lastname: Han
authors.affiliation: Departments of Urology.
authors.forename: Bumsik
authors.initials: B
authors.lastname: Hong
mesh_terms: D000328:Adult; D005260:Female; D058733:Hand-Assisted Laparoscopy / Q000379:methods*; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D009392:Nephrectomy / Q000379:methods*; D020858:Tissue and Organ Harvesting / Q000379:methods*
keywords: Hand-assisted; Intraoperative complications; Laparoscopic; Living donors; Postoperative complications