Hand-assisted laparoscopic donor nephrectomy: analysis of the learning curve in a training model in vivo

Introduction: Hand-assisted laparoscopic donor nephrectomy (HALDN) outcomes are impaired mainly by the risks associated with the learning curve. Considering that practice by in vivo training may reduced this risk, we recently assessed a swine model of HALDN. The aim of this study was to analyze the learning curve of HALDN using an in vivo training model. Materials and Methods: Ten female white pigs underwent a left and then a right HALDN in the same session for a total of 20 procedures by the same first operator. The HALDN were divided into 2 groups: group A, the first 10 nephrectomies and group B, the latter 10. For each group, we assessed operative times, intraoperative complications, estimated blood loss (EBL), warm ischemia time (WIT), and graft quality. Results: We observed a significant decrease in operative times among group B. Two right HALDN of group A were converted to open procedures owing to bleeding. The EBL was consequently lower in group B (P < .05); the mean WIT was not significantly different between the 2 study groups. The graft quality was good in 5/8 kidneys evaluated in group A and 9/10 in group B. Discussion: Standardization of analyzed parameters after a number of procedures, which were comparable to the clinical settings, confirmed the validity of this in vivo training model and its potential utility to allow many transplantation centers to adopt this technique by reducing the risk of the learning curve.