start-ver=1.4
cd-journal=joma
no-vol=86
cd-vols=
no-issue=
article-no=
start-page=7
end-page=12
dt-received=
dt-revised=
dt-accepted=
dt-pub-year=2021
dt-pub=20210228
dt-online=
en-article=
kn-article=
en-subject=
kn-subject=
en-title=
kn-title=Learning curves of minimally invasive donor nephrectomy in a high-volume center: A cohort study of 1895 consecutive living donors
en-subtitle=
kn-subtitle=
en-abstract=
kn-abstract=Background
Few studies have investigated the learning curves of minimally invasive donor nephrectomy (MIDN) using the cumulative sum (CUSUM) analysis. In addition, no study has compared the learning curves of the different surgical MIDN techniques in one cohort study using the CUSUM analysis. This study aims to evaluate and compare learning curves for several MIDN using the CUSUM analysis.
Methods
A retrospective review of consecutive donors, who underwent MIDN between 1997 and 2019, was conducted. Three laparoscopic-assisted techniques were applied in our institution and included for analysis: laparoscopic (LDN), hand-assisted retroperitoneoscopic (HARP), and robot-assisted laparoscopic (RADN) donor nephrectomy. The outcomes were compared based on surgeon volume to develop learning curves for the operative time per surgeon.
Results
Out of 1895 MIDN, 1365 (72.0%) were LDN, 427 (22.5%) were HARP, and 103 (5.4%) were RADN. The median operative time and median blood loss were 179 (IQR, 139?230) minutes and 100 (IQR, 40?200) mL, respectively. The incidence of major complication was 1.2% with no mortality, and the median hospital stay was three (IQR, 3?4) days. The CUSUM analysis resulted in learning curves, defined by decreased operative time, of 23 cases in LDN, 45 cases in HARP, and 26 cases in RADN.
Conclusions
Our study shows different learning curves in three MIDN techniques with equal post-operative complications. The LDN and RADN learning curves are shorter than that of the hand-assisted donor nephrectomy. Our observations can be helpful for informing the development of teaching requirements for fellows to be trained in MIDN.
en-copyright=
kn-copyright=
en-aut-name=TakagiKosei
en-aut-sei=Takagi
en-aut-mei=Kosei
kn-aut-name=
kn-aut-sei=
kn-aut-mei=
aut-affil-num=1
ORCID=
en-aut-name=KimenaiHendrikus J.A.N.
en-aut-sei=Kimenai
en-aut-mei=Hendrikus J.A.N.
kn-aut-name=
kn-aut-sei=
kn-aut-mei=
aut-affil-num=2
ORCID=
en-aut-name=TerkivatanTurkan
en-aut-sei=Terkivatan
en-aut-mei=Turkan
kn-aut-name=
kn-aut-sei=
kn-aut-mei=
aut-affil-num=3
ORCID=
en-aut-name=TranKhe T.C.
en-aut-sei=Tran
en-aut-mei=Khe T.C.
kn-aut-name=
kn-aut-sei=
kn-aut-mei=
aut-affil-num=4
ORCID=
en-aut-name=IjzermansJan N.M.
en-aut-sei=Ijzermans
en-aut-mei=Jan N.M.
kn-aut-name=
kn-aut-sei=
kn-aut-mei=
aut-affil-num=5
ORCID=
en-aut-name=MinneeRobert C.
en-aut-sei=Minnee
en-aut-mei=Robert C.
kn-aut-name=
kn-aut-sei=
kn-aut-mei=
aut-affil-num=6
ORCID=
affil-num=1
en-affil=Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
kn-affil=
affil-num=2
en-affil=Department of Surgery, Division of HPB & Transplant Surgery, Erasmus MC, University Medical Centre Rotterdam
kn-affil=
affil-num=3
en-affil=Department of Surgery, Division of HPB & Transplant Surgery, Erasmus MC, University Medical Centre Rotterdam
kn-affil=
affil-num=4
en-affil=Department of Surgery, Division of HPB & Transplant Surgery, Erasmus MC, University Medical Centre Rotterdam
kn-affil=
affil-num=5
en-affil=Department of Surgery, Division of HPB & Transplant Surgery, Erasmus MC, University Medical Centre Rotterdam
kn-affil=
affil-num=6
en-affil=Department of Surgery, Division of HPB & Transplant Surgery, Erasmus MC, University Medical Centre Rotterdam
kn-affil=
en-keyword=Kidney transplantation
kn-keyword=Kidney transplantation
en-keyword=Learning curve
kn-keyword=Learning curve
en-keyword=Hand-assisted laparoscopy
kn-keyword=Hand-assisted laparoscopy
en-keyword=Laparoscopy
kn-keyword=Laparoscopy
en-keyword=Living donors
kn-keyword=Living donors
en-keyword=Nephrectomy
kn-keyword=Nephrectomy
en-keyword=Teaching
kn-keyword=Teaching
en-keyword=Robotic surgical procedures
kn-keyword=Robotic surgical procedures
END