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South African Journal of Surgery

On-line version ISSN 2078-5151

S. Afr. j. surg. vol.49 n.1 Cape Town Feb. 2011

 

UROLOGY - TRANSPLANTATION

 

Overcoming the learning curve in hand-assisted laparoscopic live donor nephrectomy - a study in the animal model

 

 

J. LovelandI; C. JosephII; D. LiakosIII; R. BothaIV; R. BritzV

IM.B. B.Ch., F.C.S. (S.A.), Cert. Paed. Surg.; Transplant Unit, University of the Witwatersrand and Donald Gordon Medical Centre, Johannesburg
IIM.B. B.Ch., F.C.S. (S.A.), Cert. Gastroenterol.; Transplant Unit, University of the Witwatersrand and Donald Gordon Medical Centre, Johannesburg
IIIB.Sc., M.B. Ch.B.; Transplant Unit, University of the Witwatersrand and Donald Gordon Medical Centre, Johannesburg
IVM.B. B.Ch., F.C.S. (S.A.);Transplant Unit, University of the Witwatersrand and Donald Gordon Medical Centre, Johannesburg
VM.B. B.Ch., F.C.S. (S.A.), Cert. Vasc. Surg.;Transplant Unit, University of the Witwatersrand and Donald Gordon Medical Centre, Johannesburg

 

 


ABSTRACT

The demand for kidneys in South Africa is staggering. Only 38% of the kidney transplants done in 2008 were from related living donors. Laparoscopic living donor nephrectomy has been shown to have the advantages of decreased postoperative pain, better cosmesis and a quicker return to work when compared with the open technique. With limited surgical expertise, a realistic model was needed to overcome the learning curve.
METHODS: A total of 21 nephrectomies were performed on 12 pigs. The transperitoneal hand-assisted laparoscopic technique was used.
RESULTS: The median operative time was 75 minutes and the median warm ischaemic time 88 seconds. Three cases were aborted owing to major vascular injuries.
DISCUSSION: The advent of laparoscopic techniques has been associated with an increase in morbidity and complications in donor and recipient during the initial learning curve. We found that with our porcine model, 21 nephrectomies were adequate in overcoming the learning curve. After 15 nephrectomies no complications were noted.


 

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