Optimizing a living kidney donation program: transition to hand-assisted retroperitoneoscopic living donor nephrectomy and introduction of a passive polarizing three-dimensional display system

Optimizing a living kidney donation program is important to guarantee a high grade of acceptance among potential donors. Hand-assisted retroperitoneoscopic donor nephrectomy (HARP) is an alternative to the open anterior approach (AA) technique. Problems associated to the learning curve could hinder a transition. 3D display technique seems to ease minimally invasive surgery. Aim of this study was to evaluate the learning curve during the transition from AA to HARP and the influence of the 3D display system on the established technique. Observational study (n = 207) during transition to HARP and introduction of 3D display technique. Operation time (OT), warm ischemia time (WIT) and blood loss (BL) of HARP decreased during transition. Pairwise group comparison for OT showed a significant learning effect for the first 30 out of 50 HARPs without influence on graft function. Between AA and HARP no significant difference in OT (133 +/- 24 vs. 127 +/- 19 min, p = 0.25) but for WIT (23 +/- 28 vs. 126 +/- 40 s, p < 0.005) and BL (328 +/- 207 vs. 54 +/- 35 ml, p < 0.005) was seen. There was neither a significant difference in donors' nor recipients' eGFR. OT (98 +/- 16 vs. 106 +/- 19 min, p = 0.036) and WIT (97 +/- 37 vs. 120 +/- 57 s, p = 0.023) were significantly shorter for the 3D technique compared to 2D. A transition to HARP is possible without additional risk for the donor or loss of quality for the recipient. The learning curve for HARP is steep and short. The introduction of 3D display technique after transition facilitates the surgical preparation and could further help to optimize HARP