Troppmann Christoph, Santhanakrishnan Chandrasekar, Fananapazir Ghaneh, Troppmann Kathrin M, Perez Richard V
1 Department of Surgery, University of California , Davis, School of Medicine, Sacramento, California.
2 Department of Radiology, University of California , Davis, School of Medicine, Sacramento, California.
J Endourol. 2017 May;31(5):482-488. doi: 10.1089/end.2016.0723. Epub 2017 Feb 17.
The learning curve for laparoendoscopic single-incision live donor nephrectomy, which is technically more complex than the multiport, conventional laparoendoscopic approach, is unknown.
In a retrospective cohort study, we analyzed the learning curve of the initial 114 consecutive single-incision laparoendoscopic nephrectomies performed in nonselected live kidney donors.
Median donor body mass index was 26 kg/m (range 20-34). In all, 92% of the nephrectomies were performed on the left side; 18% of the recovered kidneys had multiple renal arteries. Cumulative sum (CUSUM) analysis of operating time (OT) demonstrated that the learning curve was achieved after case 61. For the learning curve phase (Group 1 [cases 1-61]) vs the postlearning phase (Group 2 [cases 62-114]), the difference of the mean OT was 20 minutes (p = 0.05). Mean warm ischemic time in the donors was significantly longer during the learning phase (Group 1, 6 minutes; Group 2, 5 minutes; p = 0.04). Rates of conversions to multiport procedures and of donor complications were not significantly different between Groups 1 and 2. For the recipients, we observed delayed graft function in 2 (2%) cases, no technical graft losses; and 1-year death-censored graft survival was 100% (p = n.s. for all comparisons of Group 1 vs 2).
Single-incision laparoendoscopic donor nephrectomy had a long learning curve (>60 cases), but resulted in excellent donor and recipient outcomes. The long learning curve has significant implications for the programs and surgeons who contemplate transitioning from multiport to single-incision nephrectomy. Furthermore, our observations are highly relevant for informing the development of training requirements for fellows to be trained in single-incision laparoendoscopic nephrectomy.
腹腔镜单切口活体供肾切除术在技术上比多端口传统腹腔镜手术更为复杂，其学习曲线尚不清楚。
在一项回顾性队列研究中，我们分析了114例连续接受单切口腹腔镜肾切除术的非选择性活体供肾者的学习曲线。
供者体重指数中位数为26kg/m²（范围20 - 34）。总共92%的肾切除术在左侧进行；18%的回收肾脏有多支肾动脉。手术时间的累积和（CUSUM）分析表明，在第61例手术后达到学习曲线。学习曲线阶段（第1组[第1 - 61例]）与学习后阶段（第2组[第62 - 114例]）相比，平均手术时间差异为20分钟（p = 0.05）。供者在学习阶段的平均热缺血时间明显更长（第1组，6分钟；第2组，5分钟；p = 0.04）。第1组和第2组之间多端口手术转换率和供者并发症发生率无显著差异。对于受者，我们观察到2例（2%）出现移植肾功能延迟，无技术性移植肾丢失；1年死亡截尾移植肾存活率为100%（第1组与第2组的所有比较p值均无统计学意义）。
单切口腹腔镜供肾切除术有较长的学习曲线（>60例），但供者和受者结局良好。这条长学习曲线对于考虑从多端口肾切除术过渡到单切口肾切除术的项目和外科医生具有重要意义。此外，我们的观察结果对于制定单切口腹腔镜肾切除术培训学员的培训要求具有高度相关性。
