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Optimizing a living kidney donation program: transition to hand-assisted retroperitoneoscopic living donor nephrectomy and introduction of a passive polarizing three-dimensional display system

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Abstract

Background

Optimizing a living kidney donation program is important to guarantee a high grade of acceptance among potential donors. Hand-assisted retroperitoneoscopic donor nephrectomy (HARP) is an alternative to the open anterior approach (AA) technique. Problems associated to the learning curve could hinder a transition. 3D display technique seems to ease minimally invasive surgery. Aim of this study was to evaluate the learning curve during the transition from AA to HARP and the influence of the 3D display system on the established technique.

Methods

Observational study (n = 207) during transition to HARP and introduction of 3D display technique.

Results

Operation time (OT), warm ischemia time (WIT) and blood loss (BL) of HARP decreased during transition. Pairwise group comparison for OT showed a significant learning effect for the first 30 out of 50 HARPs without influence on graft function. Between AA and HARP no significant difference in OT (133 ± 24 vs. 127 ± 19 min, p = 0.25) but for WIT (23 ± 28 vs. 126 ± 40 s, p < 0.005) and BL (328 ± 207 vs. 54 ± 35 ml, p < 0.005) was seen. There was neither a significant difference in donors’ nor recipients’ eGFR. OT (98 ± 16 vs. 106 ± 19 min, p = 0.036) and WIT (97 ± 37 vs. 120 ± 57 s, p = 0.023) were significantly shorter for the 3D technique compared to 2D.

Conclusion

A transition to HARP is possible without additional risk for the donor or loss of quality for the recipient. The learning curve for HARP is steep and short. The introduction of 3D display technique after transition facilitates the surgical preparation and could further help to optimize HARP.

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Authors and Affiliations

  1. Division of Transplantation Surgery, Department of General, Visceral and Cancer Surgery, Transplant Center Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany

    Roger Wahba, Robert Kleinert, Nadine Heiermann, Georg Dieplinger, Hans A. Schlößer, Denise Buchner & Dirk L. Stippel

  2. Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany

    Martin Hellmich

  3. Department II of Internal Medicine, Center for Molecular Medicine Cologne, Transplant Center Cologne, University of Cologne, Cologne, Germany

    Christine Kurschat

Authors
  1. Roger Wahba
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  2. Robert Kleinert
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Correspondence to Roger Wahba.

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Roger Wahba, Robert Kleinert, Martin Hellmich, Nadine Heiermann, Georg Dieplinger, Hans A. Schlößer, Denise Buchner, Christine Kurschat and Dirk L. Stippel have no conflicts of interest or financial ties to disclose.

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Wahba, R., Kleinert, R., Hellmich, M. et al. Optimizing a living kidney donation program: transition to hand-assisted retroperitoneoscopic living donor nephrectomy and introduction of a passive polarizing three-dimensional display system. Surg Endosc 31, 2577–2585 (2017). https://doi.org/10.1007/s00464-016-5264-4

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  • DOI: https://doi.org/10.1007/s00464-016-5264-4

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