A novel difficulty grading system for laparoscopic living donor nephrectomy

Takagi, Kosei; Kimenai, Hendrikus J. A. N.; Terkivatan, Türkan; Tran, Khe T. C.; IJzermans, Jan N. M.; Minnee, Robert C.

doi:10.1007/s00464-020-07727-w

Cited by 7 publications

(6 citation statements)

References 21 publications

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“…[8][9][10]13,22 Previous research studies show that BMI, male, and multiple anatomy of the arteries may prolong the surgery time. 23,24 In our study, these factors did not differ between LDN and RADN. Moreover, it is expected that surgeons go through a learning curve for robot-assisted surgery.…”

Section: Discussioncontrasting

confidence: 46%

Effective and safe implementation of robot‐assisted donor nephrectomy by experienced laparoscopic surgeons

van de Geijn,

Janki,

de Vries

et al. 2024

World j. surg.

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BackgroundIn June 2021, the first robot‐assisted donor nephrectomy (RADN) was performed at the Leiden University Medical Center (LUMC), the Netherlands. The goal of this study was to investigate whether this procedure has been implemented safely and efficiently.MethodsRADN was retrospectively compared to laparoscopic donor nephrectomy (LDN) performed during the same time period (June 2021 until November 2022). Patients were assigned to RADN depending on the availability of the da Vinci robot and surgical team. The studied endpoints were postoperative complications, operative time, estimated blood loss, warm ischemic time (WIT), and postoperative pain experience. For analysis, the Student's t‐test and Chi‐squared test were used for, respectively, continuous and categorical data.ResultsForty RADN were compared to 63 LDN. Total insufflation time was significantly longer in RADN compared to LDN (188 min (169–214) versus 172 min (144–194); p = 0.02). Additionally, WIT was also found to be significantly higher in the robot‐assisted group (04:54 min vs. 04:07 min; p < 0.01). No statistical differences were found in postoperative outcomes (eGFR of the recipient at 3‐month follow‐up, RADN 54.08 mL/min ±18.79 vs. LDN 56.41 mL/min ±16.82; p = 0.52), pain experience, and complication rate.ConclusionRADN was safely and efficiently implemented at the LUMC. It's results were not inferior to laparoscopic donor nephrectomy. Operative time and warm ischemic times were longer in RADN. This may relate to a learning curve effect. No clinically relevant effect on postoperative outcomes was observed.

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Section: Discussioncontrasting

confidence: 46%

Effective and safe implementation of robot‐assisted donor nephrectomy by experienced laparoscopic surgeons

van de Geijn,

Janki,

de Vries

et al. 2024

World j. surg.

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“…21 In contrast, in a study of 1741 laparoscopic donor nephrectomies, renal arteries and veins were analyzed separately and were both significantly associated with prolonged operative times. 22 Based on our experience, we considered that the load for processing one artery would be similar to that for one vein; hence, the renal arteries and veins were analyzed together. Patients with two arteries and one vein (three vessels) and those with one artery and two veins (three vessels) were assigned to the same group for analysis.…”

Section: Discussionmentioning

confidence: 99%

“…The number of renal arteries or veins has been assessed as a factor associated with prolonged operative time in radical or donor nephrectomies; 21,22 however, the results of these previous studies are conflicting. One study assessed the number of renal arteries with various body habitus factors and found no significant differences in the operative time of LRN between patients with one artery and those with two or more arteries 21 .…”

Section: Discussionmentioning

confidence: 99%

“…One study assessed the number of renal arteries with various body habitus factors and found no significant differences in the operative time of LRN between patients with one artery and those with two or more arteries 21 . In contrast, in a study of 1741 laparoscopic donor nephrectomies, renal arteries and veins were analyzed separately and were both significantly associated with prolonged operative times 22 . Based on our experience, we considered that the load for processing one artery would be similar to that for one vein; hence, the renal arteries and veins were analyzed together.…”

Section: Discussionmentioning

confidence: 99%

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Preoperative factors affecting the operative outcomes of laparoscopic nephrectomy

et al. 2022

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Abbreviations & Acronyms 3D = three-dimensional AI = artificial intelligence AUC = area under the curve BMI = body mass index CI = confidence interval CT = computed tomography EBL = estimated blood loss IQR = interquartile range LRN = laparoscopic radical nephrectomy OR = odds ratio PT = pneumoperitoneum time RCC = renal cell carcinoma ROC = receiver operating characteristic VFA = visceral fat area VFV = visceral fat volume

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“…28 Proficiencybased guidance, part-task training, and assigning practice over time might optimize the learning curve. 29 There were other problematic factors, such as obese donors prolonged the surgery time then affected the learning curve. 6 A few millimeters of perinephric fat would significantly prolong the surgery time.…”

Section: Minimally Invasive Techniques Are the Preferred Technique Fo...mentioning

confidence: 99%

Transition from transperitoneal to retroperitoneal approach in laparoscopic living donor nephrectomy: team-based and individual learning curve: a cross-sectional study

Wahyudi,

Adriansyah,

Yonathan

et al. 2023

F1000Res

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Background: Laparoscopic living donor nephrectomy (LLDN) is a standard practice for kidney donor transplantation due to fewer complications associated with the treatment. Retroperitoneal approach to LLDN is thought to be more advantageous in preventing injuries to various abdominal organs. However, the transition process from transperitoneal to retroperitoneal LLDN is important to ensure the best outcome for the patients. The aim of this study was to investigate the learning curve for retroperitoneal approach in LLDN among urologists in an individual and team-based approach Methods: A retrospective analysis of retroperitoneal LLDN was performed on procedures performed by a kidney donor team consisting of four urologists from January 2019 to January 2022 at Cipto Mangunkusumo National General Hospital, Indonesia. The data were taken from pre-existing medical records. The learning curve for the operation time, warm ischemic time, and estimated blood loss was analyzed using cumulative sum (CUSUM) analysis. Phase 1 represents the initial learning curve, the phase 2 plateau represents the period of proficiency, while phase 3 represents the mastery period. Results: A total of 127 retroperitoneal LLDN procedures were done during the study period by four operators with various experience. The average procedure needed to achieve proficiency was 16.5 procedures. Meanwhile, the average procedure needed to achieve mastery was 28 procedures. Shorter learning curve was achieved by operators with more experience in other laparoscopic procedures. Conclusions: The learning curve for transition from transperitoneal to retroperitoneal approach to LLDN is relatively short and feasible for both individuals and teams of urologists. Therefore, transition to retroperitoneal approach is a feasible option to reduce the complication rate of LLDN.

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A novel difficulty grading system for laparoscopic living donor nephrectomy

Cited by 7 publications

References 21 publications

Effective and safe implementation of robot‐assisted donor nephrectomy by experienced laparoscopic surgeons

Effective and safe implementation of robot‐assisted donor nephrectomy by experienced laparoscopic surgeons

Preoperative factors affecting the operative outcomes of laparoscopic nephrectomy

Transition from transperitoneal to retroperitoneal approach in laparoscopic living donor nephrectomy: team-based and individual learning curve: a cross-sectional study

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