title: Learning Curve for Laparoendoscopic Single-Incision Live Donor Nephrectomy: Implications for Laparoendoscopic Practice and Training.
abstract: The learning curve for laparoendoscopic single-incision live donor nephrectomy, which is technically more complex than the multiport, conventional laparoendoscopic approach, is unknown.
  
  
  
  In a retrospective cohort study, we analyzed the learning curve of the initial 114 consecutive single-incision laparoendoscopic nephrectomies performed in nonselected live kidney donors.
  
  
  
  Median donor body mass index was 26 kg/m2(range 20-34). In all, 92% of the nephrectomies were performed on the left side; 18% of the recovered kidneys had multiple renal arteries. Cumulative sum (CUSUM) analysis of operating time (OT) demonstrated that the learning curve was achieved after case 61. For the learning curve phase (Group 1 [cases 1-61]) vs the postlearning phase (Group 2 [cases 62-114]), the difference of the mean OT was 20 minutes (p = 0.05). Mean warm ischemic time in the donors was significantly longer during the learning phase (Group 1, 6 minutes; Group 2, 5 minutes; p = 0.04). Rates of conversions to multiport procedures and of donor complications were not significantly different between Groups 1 and 2. For the recipients, we observed delayed graft function in 2 (2%) cases, no technical graft losses; and 1-year death-censored graft survival was 100% (p = n.s. for all comparisons of Group 1 vs 2).
  
  
  
  Single-incision laparoendoscopic donor nephrectomy had a long learning curve (>60 cases), but resulted in excellent donor and recipient outcomes. The long learning curve has significant implications for the programs and surgeons who contemplate transitioning from multiport to single-incision nephrectomy. Furthermore, our observations are highly relevant for informing the development of training requirements for fellows to be trained in single-incision laparoendoscopic nephrectomy.
authors.affiliation: 1 Department of Surgery, University of California , Davis, School of Medicine, Sacramento, California.
authors.forename: Christoph
authors.initials: C
authors.lastname: Troppmann
authors.affiliation: 1 Department of Surgery, University of California , Davis, School of Medicine, Sacramento, California.
authors.forename: Chandrasekar
authors.initials: C
authors.lastname: Santhanakrishnan
authors.affiliation: 2 Department of Radiology, University of California , Davis, School of Medicine, Sacramento, California.
authors.forename: Ghaneh
authors.initials: G
authors.lastname: Fananapazir
authors.affiliation: 1 Department of Surgery, University of California , Davis, School of Medicine, Sacramento, California.
authors.forename: Kathrin M
authors.initials: KM
authors.lastname: Troppmann
authors.affiliation: 1 Department of Surgery, University of California , Davis, School of Medicine, Sacramento, California.
authors.forename: Richard V
authors.initials: RV
authors.lastname: Perez
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006085:Graft Survival; D006801:Humans; D007674:Kidney Diseases / Q000601:surgery; D016030:Kidney Transplantation / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D059032:Learning Curve; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D061646:Operative Time; D010351:Patient Discharge; D010359:Patient Readmission; D012189:Retrospective Studies; D020858:Tissue and Organ Harvesting / Q000379:methods; D016896:Treatment Outcome; D052096:Warm Ischemia; D055815:Young Adult
keywords: donor nephrectomy; learning curve; outcomes; single incison laparoendoscopic surgery