#0931

LEARNING CURVE OF ROBOTIC LIVING DONOR NEPHRECTOMY: RESULTS FROM A HIGH VOLUME TRANSPLANTATION CENTER

M. Pham¹, M. Thai¹

¹Cho Ray Hospital, Urology, Ho Chi Minh, Vietnam

Introduction:

Laparoscopic living donor nephrectomy (LDN) has been the standard procedure for kidney transplantation from living donors across numerous institutions globally. The utilization of the robotic system provides superior attributes that facilitate the surgical process and diminish the learning curve. Since the inception of this technique in May 2018, we have conducted an analysis of the learning curve associated with the robotic living donor nephrectomy (RDN) for harvesting the left kidney at our center.

Material and methods:

An analysis was conducted on a sequence of consecutive cases performed by the same surgical team for left nephrectomy. To mitigate confounding factors, we analyzed cases involving simple renal vascular structures, specifically those consisting of a single artery and a single vein, without any abnormalities present at the origin of the artery or at the confluence of the veins. The research was carried out at Cho Ray Hospital from May 2018 to February 2025. Demographic, clinical, and subclinical variables, along with surgical outcomes and complications, were documented.

Results:

Among more than 1000 cases of traditional laparoscopic and robotic living donor nephrectomy, a total of 30 patients with uncomplicated renal vascular structures who underwent left robotic LDN were analyzed. Mean age of the participants was 47.6 ± 8.6 (29 - 61) years. Male-to-female ratio was 1:1. The mean BMI was 23.1 ± 2.4 (19.1 - 28.9) kg/m². Mean operative time was 201.3 ± 48.6 (120–300) minutes, with an estimated blood loss of 68.7 ± 44.9 (20–200) mL. Mean warm ischemic time was 5.0 ± 1.2 (3 - 8) minutes. Neither intraoperative complications nor open conversions were observed. Two cases of postoperative lymphatic leakage were treated medically. Mean hospital stay was 3.7 ± 2.0 days. Mean serum creatinine was 1,04 ± 0,26 mg/dl after 1 month. Analysis of the learning curve revealed that operation time and console time showed significant improvement after the initial 15 cases (cubic regression, r² = 0.426). Mean operation time for the first 15 cases compared to the next 15 cases was 220 vs 182 mins (Δt = -38 mins, p=0.033). Similarly, the mean console time in these two groups was 159 vs 123 mins (Δt = -36 mins, p=0.033).