Laparoendoscopic Single-site Plus 1-port Donor Nephrectomy: Division of Roles to Shorten Warm Ischemic Time

• Published in: Transplantation proceedings 2018-06, Vol.50 (5), p.1238-1242
• Main Authors: Nitta, M., Kawamura, Y., Uchida, T., Kano, T., Yuzuriha, S., Otaki, T., Umemoto, T., Shimizu, Y., Kawakami, M., Kim, H., Nakajima, N., Hanai, K., Shoji, S., Uehara, S., Takiguchi, S., Ishida, H., Nakamura, M., Terachi, T., Miyajima, A.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Conversion to Open Surgery - statistics & numerical data; Female; Humans; Kidney Transplantation - methods; Laparoscopy - methods; Learning Curve; Length of Stay; Living Donors; Male; Middle Aged; Nephrectomy - methods; Operative Time; Retrospective Studies; Tissue and Organ Harvesting - methods; Warm Ischemia - methods
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2018.02.077

In this study we present our new surgical procedure, laparoendoscopic single-site surgery plus 1 for donor nephrectomy (LESS+1-DN), which shortens warm ischemic time (WIT) and improves surgical outcomes. From January 2013 to February 2017, 15 patients who underwent LESS-DN and 41 patients who underwent LESS+1-DN at our institution were evaluated retrospectively. Patients were divided into 3 groups: group A, 15 cases of LESS-DN; group B, the first 15 patients who underwent LESS+1-DN; and group C, 26 patients who underwent subsequent LESS+1-DN. To reduce WIT, we clearly defined the roles of the surgeon and first assistant in the 26 subsequent LESS+1-DN cases. The surgeon dissected the renal pedicle and harvested the kidney graft using a recovery bag and the first assistant held the recovery bag. The mean operative time in group C (213.7 minutes) was significantly shorter than that in groups A (253.3 minutes) and B (253.8 minutes). The WIT in group C (195.2 seconds) was significantly shorter than that in groups A (389.8 seconds) and B (313.2 seconds). Open conversion was required in 1 case in group A. None of the donors required conversion to open surgery and no perioperative complications occurred in groups B and C. Linear regression analysis of the LESS+1-DN operative times and consecutive case numbers demonstrated a shallow learning curve (R2 = 0.392, P < .05). Our new procedure that divides the roles of the operator and the first assistant contributed significantly to a shortening of WIT. Dividing roles can facilitate a safer laparoscopic donor nephrectomy. •We report our results of a procedure called laparoendoscopic plus 1 living donor nephrectomy (LESS+1-DN).•We compared operative times and warm ischemic times in the first 15 LESS+1-DN cases and 26 later LESS+1-DN cases.•To reduce WIT, we defined the roles of the surgeon and first assistant in the later 26 LESS+1-DN cases.•The mean operative time and mean warm ischemic time were significantly shorter in the later 26 LESS+1-DN cases.