Department of Urology, Beijing Friendship hospital, Capital Medical University, Beijing, China.
Institute of Urology, Beijing Municipal Health Commission, Beijing, China.
BMC Urol. 2024 Sep 3;24(1):191. doi: 10.1186/s12894-024-01581-x.
We aimed to introduce our modified hand-assisted retroperitoneoscopic living donor nephrectomy (HARPLDN) technique and define the learning curve.
One hundred thirty-eight kidney donors who underwent modified HARPLDN by the same surgeon between May 2015 and March 2022 were included. A cumulative sum (CUSUM) learning curve analysis was performed with the total operation time as the study outcome.
In total, the mean operative time was 138.2 ± 32.1 min. The median warm ischemic time (WIT) and estimated blood loss were 90 s and 50 ml, respectively. The learning curve for the total operative time was best modeled as a second-order polynomial with the following equation: CUSUM (min) = (-0.09 case number) + (12.88 case number) - 67.77 (R = 0.7875; p<0.05). The CUSUM learning curve included the following three unique phases: phase 1 (the initial 41 cases), representing the initial learning curve; phase 2 (the middle 43 cases), representing expert competence; and phase 3 (the final 54 cases), representing mastery. The overall 6-month graft survival rate was 99.3%, with 94.9% immediate onset of graft function without delayed graft function and 0.7% ureteral complications.
Our modified method is safe and effective for living donor nephrectomy and has the advantages of a shorter operating time and optimized WIT. The surgeon can become familiar with the modified HARPLDN after 41 cases and effectively perform the next 97 cases.
我们旨在介绍改良手助后腹腔镜活体供肾切除术（HARPLDN）技术，并定义学习曲线。
纳入 2015 年 5 月至 2022 年 3 月间由同一位外科医生实施改良 HARPLDN 的 138 例供肾者。以总手术时间为研究结果，采用累积和（CUSUM）学习曲线分析。
总手术时间平均为 138.2±32.1 分钟。中位热缺血时间（WIT）和估计失血量分别为 90 秒和 50 毫升。总手术时间的学习曲线最好用二次多项式拟合，方程为：CUSUM（min）=（-0.09 例数）+（12.88 例数）-67.77（R=0.7875；p<0.05）。CUSUM 学习曲线包括以下三个独特阶段：阶段 1（最初的 41 例），代表初始学习曲线；阶段 2（中间的 43 例），代表专家能力；阶段 3（最后的 54 例），代表掌握。整体 6 个月移植物存活率为 99.3%，无延迟移植物功能，立即出现移植物功能的占 94.9%，输尿管并发症占 0.7%。
我们的改良方法对活体供肾切除术安全有效，具有手术时间更短和优化 WIT 的优点。外科医生在完成 41 例后可以熟悉改良的 HARPLDN，并有效地完成接下来的 97 例。
