Overcoming the learning curve in hand-assisted laparoscopic live donor nephrectomy - a study in the animal model

  • J Loveland Department of Surgery, University of the Witwatersrand
  • C Joseph Department of Surgery, University of the Witwatersrand
  • D Liakos Department of Surgery, University of the Witwatersrand
  • R Botha Department of Surgery, University of the Witwatersrand
  • R Britz Department of Surgery, University of the Witwatersrand
DOI: https://doi.org/10.7196/sajs.637
Keywords: Hand-assisted, living, donor, nephrectomy, porcine model, learning curve

Abstract

The demand for kidneys in South Africa is staggering. Only 38% of the kidney transplants done in 2008 were from related living donors. Laparoscopic living donor nephrectomy has been shown to have the advantages of decreased postoperative pain, better cosmesis and a quicker return to work when compared with the open technique. With limited surgical expertise, a realistic model was needed to overcome the learning curve. Methods. A total of 21 nephrectomies were performed on 12 pigs. The transperitoneal hand-assisted laparoscopic technique was used. Results. The median operative time was 75 minutes and the median warm ischaemic time 88 seconds. Three cases were aborted owing to major vascular injuries. Discussion. The advent of laparoscopic techniques has been associated with an increase in morbidity and complications in donor and recipient during the initial learning curve. We found that with our porcine model, 21 nephrectomies were adequate in overcoming the learning curve. After 15 nephrectomies no complications were noted.

Author Biographies

J Loveland, Department of Surgery, University of the Witwatersrand
Paediatric and Transplant Surgeon, Transplant Unit, University of the Witwatersrand and Donold Gordon Medical Centre, Johannesburg
C Joseph, Department of Surgery, University of the Witwatersrand
GIT and Transplant Surgeon, Transplant Unit, University of the Witwatersrand and Donold Gordon Medical Centre, Johannesburg
R Botha, Department of Surgery, University of the Witwatersrand
Professor, Endocrine and Transplant Surgeon, Transplant Unit, University of the Witwatersrand and Donold Gordon Medical Centre
R Britz, Department of Surgery, University of the Witwatersrand
Professor and Head of Transplant Unit, Transplant Unit, University of the Witwatersrand and Donold Gordon Medical Centre, Johannesburg
Published
2011-03-14
How to Cite
Loveland, J., Joseph, C., Liakos, D., Botha, R., & Britz, R. (2011). Overcoming the learning curve in hand-assisted laparoscopic live donor nephrectomy - a study in the animal model. South African Journal of Surgery, 49(1), 13-16. https://doi.org/10.7196/sajs.637
Issue
Vol 49 No 1 (2011)
Section
Urology - Transplantation

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