Development of a human cadaver model for training in laparoscopic donor nephrectomy.
The organ procurement network recommends a surgeon record 15 cases as surgeon or assistant for laparoscopic donor nephrectomies (LDN) prior to independent practice. The literature suggests that the learning curve for improved perioperative and patient outcomes is closer to 35 cases. In this article, we describe our development of a model utilizing fresh tissue and objective, quantifiable endpoints to document surgical progress, and efficiency in each of the major steps involved in LDN.



Phase I of model development focused on the modifications necessary to maintain visualization for laparoscopic surgery in a human cadaver. Phase II tested proposed learner-based metrics of procedural competency for multiport LDN by timing procedural steps of LDN in a novice learner.



Phases I and II required 12 and nine cadavers, with a total of 35 kidneys utilized. The following metrics improved with trial number for multiport LDN: time taken for dissection of the gonadal vein, ureter, renal hilum, adrenal and lumbrical veins, simulated warm ischemic time (WIT), and operative time.



Human cadavers can be used for training in LDN as evidenced by improvements in timed learner-based metrics. This simulation-based model fills a gap in available training options for surgeons.
Hiram C. Polk Jr. Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA.
Erica R H
0000-0002-8281-1936
ERH
Sutton
Hiram C. Polk Jr. Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA.
Adrian
A
Billeter
Hiram C. Polk Jr. Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA.
Devin
D
Druen
Hiram C. Polk Jr. Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA.
Henry
H
Roberts
Hiram C. Polk Jr. Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA.
Jonathan
J
Rice
D002102:Cadaver; D006801:Humans; D007668:Kidney / Q000601:surgery*; D010535:Laparoscopy / Q000193:education* / Q000379:methods; D059032:Learning Curve; D008954:Models, Biological; D009392:Nephrectomy / Q000193:education* / Q000379:methods; D020858:Tissue and Organ Harvesting / Q000193:education* / Q000379:methods
donor nephrectomy; human cadaver; laparoscopy; simulation; training