Ann Surg Treat Res.  2024 Aug;107(2):81-90. 10.4174/astr.2024.107.2.81.

Learning curve analysis for hand-assisted laparoscopic living donor nephrectomy: an analysis of 96 consecutive cases performed by a trained gastrointestinal surgeon

• Choi CI
• Lee KJ
• Kim MJ
• Park JK
• Kim DW
• Kim HJ
• Rhee H
• Song SH
• Seong EY
• Kim DH
• Jeon TY
• Jung HJ

• KMID: 2558384
• DOI: http://doi.org/10.4174/astr.2024.107.2.81

Abstract

Purpose
This study aims to analyze the learning curve of hand-assisted laparoscopic living donor nephrectomy (HLDN) conducted by a trained gastrointestinal surgeon.
Methods
A retrospective analysis was performed on the perioperative clinical data of 96 consecutive patients who underwent HLDN from May 2013 to March 2023. The learning curve was evaluated using the cumulative sum (CUSUM) test based on operation time and risk-adjusted CUSUM for postoperative complications. Patients were divided into three groups (novice, development, and competency phases) based on changes in operation time. Patient demographics and perioperative outcomes were compared between each group.
Results
Among the patients, 35 were male, with a mean age of 48.9 ± 11.3 years and a mean body mass index (BMI) of 24.5 ± 3.2 kg/m 2 . The novice phase (phase 1) included the first 30 cases, with the development phase (phase 2) up to the 65th case. Operation times were significantly different across phases, averaging 263.2 ± 33.4, 211.1 ± 34.4, and 161.1 ± 31.3 minutes for phases 1, 2, and 3, respectively (P < 0.001). Blood loss decreased gradually across phases (phase 1, 264.7 ± 144.4 mL; phase 2, 239.7 ± 166.3 mL; phase 3, 198.8 ± 103.5 mL), though not statistically significant. BMI impacted operation time only in phase 1. Overall postoperative complications occurred in 13 cases (Clavien-Dindo grade I, 4 cases; grade II, 9 cases), with no significant differences across phases.
Conclusion
HLDN can be safely performed by a trained gastrointestinal surgeon, with approximately 30 cases needed to achieve proficiency.

Keyword

Laparoscopy; Learning curve; Minimally invasive surgical procedures; Nephrectomy

Figure

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  Fig. 1 The cumulative sum (CUSUM) chart. OT, operation time; RA-CUSUM, risk-adjusted CUSUM.

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  Fig. 2 Changes in the operation time and body mass index (BMI) according to the cases.

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  Fig. 3 Fig. 3. Relation between the operation time and body mass index (BMI).

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  Fig. 4 Changes in postoperative pain. POD, postoperative day.

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