Telementoring Facilitates Independent Hand-Assisted Laparoscopic Living Donor Nephrectomy

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Abstract

Laparoscopic living donor nephrectomy is a major advance but a challenging procedure to learn even after laparoscopic training. It requires significant previous training in both laparoscopic and transplant surgery. Telementoring has been shown to reduce the laparoscopic learning curve in other fields. Of six cases of hand-assisted laparoscopic (HAL) living donor nephrectomy at our institution, an on-site mentor supervised the initial two. We present the subsequent four cases as the first documented examples of telementored HAL live donor nephrectomy. Telelink was established with a Comstation (Zydacron, UK) incorporating a Z360 telementoring codec and four ISDN lines (512 kb/s) with time delay of 500 ms for both audio and video. The remote surgeon in Minnesota (USA) could change independently between the laparoscopic and external views. The operating surgeons were able to look at the mentor and converse with him throughout. There were no adverse events in recipients and graft function was excellent. With regards to the telementored group the mean operative time was 240 minutes, the mean warm ischemic time 189 seconds, the mean estimated blood loss 171 mL, and the mean length of hospital stay 3 days. Telementoring for laparoscopic donor nephrectomy is feasible, effective, and likely to aid independent practice by providing continued supervision and reducing the learning period.

Section snippets

Methods

A standard hand-assisted living donor nephrectomy surgical technique was used in all locally mentored, telementored, and independent cases. Under a general anesthetic patients were placed in the right lateral position and all donor organs were removed from the left side. A Gelport (Applied Medical) was placed in the midline above the level of the umbilicus and two further laparoscopic ports (one camera and one instrument) were introduced on the patient's left side. The transatlantic connection

Results

All procedures were completed laparoscopically without operative complication. There were no conversions to open surgery, postoperative complications, or blood transfusions required in any subgroup. The laparoscopic and hand-port wounds all healed well and the 2-week pain score was 0 for all donors. There were no adverse events in recipients and graft function was excellent. With regards to the telementored group the mean operative time was 240 minutes, the mean warm ischemia time 189 seconds,

Discussion

HALDN is a relatively new and effective technique designed to make kidney donation more attractive and minimally invasive without affecting recipient outcomes. It allows kidneys to be harvested with short operating and warm ischemia times.12 The operative and postoperative parameters for our telementored group and the subsequent independent practice group compare favorably with the large published series of HAL living donor nephrectomy13 and a recent systematic review.14 In particular the mean

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This work was supported by Guy's Hospital Research Funds.

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