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Living Donor Research Living Donor Risks Living Kidney Donor

Surgeon’s Learning Curve Endangers Living Kidney Donor

This recently published paper followed one surgeon as he performed 60 living donor nephrectomies. The first 30 were hand-assisted laparoscopic and the second 30 were pure laparoscopic. Here’s how his patients fared (emphasis mine):

 

Thirteen patients (43.3%) in the [hand-assisted] group experienced a total of 17 intraoperative errors, and 11 (36.7%) in the [pure lap] group experienced a total of 14 intraoperative errors.

The most common intraoperative complication was adrenal gland injury (two intra-adrenal hematomas and 10 adrenal gland injuries, including 7 that required repair).
Twenty-six patients (86.7%) in the [hand-assisted] group experienced a total of 47 postoperative complications, and 21 (70.0%) in the [pure lap] group experienced a total of 28 postoperative complications.

Ileus and aspartate aminotransferase/alanine aminotransferase elevation were commonly reported in the [hand-assisted] group.

Note: Ileus refers to the intestine. Aspartate aminotransferase refers to an enzyme that is released when tissue/organs are damaged. The higher the level, the more damage the tissue/organ has sustained

 

Three patients experienced major postoperative complications, defined as grade II or higher. One patient in the [hand-assisted] group had prolonged chyle leakage (aka lymph leakage) from a Jackson-Pratt drain; this patient was treated with long-term drainage (14 days) and a low-fat diet.

One patient in the [pure lap] group underwent wound revision under local anesthesia for wound dehiscence (in other words, the wound ruptured along the surgical site).

A second patient in the [pure lap] group had a blood transfusion for postoperative bleeding. However, this bleeding originated mainly from a concomitantly performed ovarian cystectomy site and menstruation.

 

If all of this horrifies you, which it should, the conclusion should trip your gag reflex:

“The technical transition from HALDN [hand-assisted] to PLDN [pure lap] does not involve a steep learning curve for surgeons less experienced with laparoscopic renal surgery and maintains similar perioperative donor and graft outcomes.”

Somehow I doubt those wounded kidney donors would agree.

 

 

ETA 8-17-2015: When this link was posted on a LD-related FB group, someone remarked that potential living donors should make sure they know their surgeon’s experience level. Obviously, i agree with this sentiment, but it’s not that simple. It’s not required that surgeons disclose this information and there is no way to confirm or crosscheck a potential surgeon’s answer to the question. That doesn’t mean a potential donor shouldn’t ask though. The surgeon’s reaction to the query itself might communicate a lot about his/her veracity and/or attitude toward patients advocating for themselves.If s/he attempts to intimidate or brush off the question, that might be a good sign to find another surgeon.

 

 

You, D., Lee, C., Jeong, I., Han, D., & Hong, B. (2015). Transition From Hand-Assisted to Pure Laparoscopic Donor Nephrectomy JSLS : Journal of the Society of Laparoendoscopic Surgeons, 19 (3) DOI: 10.4293/JSLS.2015.00044

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