Laparoscopic donor nephrectomy: Short learning curve

Introduction: The learning curve of laparoscopic donor nephrectomy (LDN) may represent a great technical challenge at centers with low volume of living donors. The number of LDNs required to overcome the learning curve is still unclear. Here we report the modality of approach to LDN at a low-volume living donor transplant center. Materials and methods: We reviewed the records of two groups of donors operated by two different surgeons between January 2002 and October 2005. We compared donor hospital stay, operative time, presence of multiple renal arteries, blood loss, operative details, and complications. Results: The first six operations (group A) were performed by a well-trained laparoscopic surgeon (A.P.) with a consolidated experience in the LDN procedure, attended by our training surgeon (R.D.V.) who conducted the other six cases (group 13). No conversion to an open procedure was necessary and there were no major minor complications. Mean operative time was 267.5 (+/- 55.9) minutes in group A and 300 (+/- 43.4) minutes in group B (P =.28). Mean warm ischemia time was 125 (+/- 61.6) seconds in group A and 189.2 (+/- 18.6) seconds in group B (P =.035). Mean hospital stay was 5.3 days in group A and 5.6 days in group B. Conclusions: LDN can be performed safely and efficiently in transplant centers with initial experience. A collaborative approach to this difficult procedure with a surgeon skilled in donor nephrectomy minimizes the risk to the donor and reduces the learning curve.