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ENDOUROLOGY
& LAPAROSCOPY
One
versus two proficient laparoscopic surgeons for laparoscopic live donor
nephrectomy
Siqueira Jr TM, Gardner TA, Kuo RL, Paterson RF, Stevens LH, Lingeman
JE, Shalhav AL
From the Department of Urology, Indiana University School of Medicine;
Methodist Hospital Institute for Kidney Stone Disease; Department of General
Surgery, Methodist Hospital of Indiana; Clarian Health Partners, Indianapolis,
Indiana, USA
Urology 2002; 60:406-9
- Objectives:
To compare the laparoscopic donor nephrectomy (LDN) results obtained
by two different surgical teams, one consisting of a proficient laparoscopic
surgeon assisted by an inexperienced laparoscopic surgeon and another
consisting of two proficient laparoscopic surgeons. With more centers
embarking on LDN programs, it is important to identify the factors that
can improve overall outcomes during the initial learning curve.
- Methods:
A retrospective review was performed of the initial 70 sequential LDNs
performed between October 1998 and March 2001 at our institutions. The
procedures were stratified into two groups. Group 1 consisted of LDN
cases performed by one proficient laparoscopic surgeon and an inexperienced
laparoscopic surgeon (resident, fellow, or faculty) as the first assistant;
group 2 consisted of cases performed by two proficient laparoscopic
surgeons.
- Results:
Twenty-six
LDNs were performed by group 1 and 44 by group 2. The total operative
time and estimated blood loss showed a statistically significant decrease
in group 2 compared with group 1, 143 ± 32 minutes versus 218
± 38 minutes (P<0.001) and 92 ± 115 mL versus 158 ±
148 mL (P=0.044), respectively. Two major complications occurred in
group 1 (7.7%) and two major complications occurred in group 2 (4.5%).
The 3-month postoperative recipient creatinine levels were similar for
both groups, 1.6 ± 1.3 versus 1.4 ± 0.4 (P=0.408).
- Conclusions:
A surgical team composed of two proficient laparoscopic surgeons during
the early learning curve of LDN may allow safe and efficient development
of a laparoscopic live donor renal transplantation program.
- Editorial
Comment
Following this article is an excellent editorial by Cadeddu from Dallas,
TX, USA. He correctly points out that, the only clinically significant
advantage in this series of having 2 experienced laparoscopic surgeons
performing the operation, was a shorter operative time. While this is
certainly a reasonable goal, the more important endpoints, such as complications
and transplant function, were no different between the two groups. I
agree with Cadeddu that the availability of 2 experienced laparoscopic
surgeons is a luxury not available at most centers. If such staffing
is available, the data in this article confirms that this might decrease
operative time, but the centers where such staffing is not available
should be reassured by the data as well - in that the important endpoints
of complications and transplant function were just as good when there
was only one experienced laparoscopic surgeon performing the operation.
This is not to say that starting a laparoscopic donor program should
be taken lightly; there should be at least one experienced laparoscopic
surgeon involved, and preparation should be thorough.
Dr.
J. Stuart Wolf Jr.
Associate Professor of Urology
University of Michigan
Ann Arbor, Michigan, USA
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