Solo-Surgeon Pure Laparoscopic Living Donor Nephrectomy Using Passive Camera Holder: Pilot Study

Abstract

INTRODUCTION: Safe surgery is of utmost importance for living kidney donors undergoing surgery that is not intended for their health. This leads to the development of minimally invasive donor nephrectomy techniques. For stable surgery during laparoscopic surgery, Surgical vision as seen on the camera should be provided to the surgeon stably. The camera holder can provide the stable surgical vision intended by the surgeon without shaking. Solo-surgery can be defined as a practice of a surgeon operating alone using a camera holder, without other surgical members except for a scrub nurse. This IDEAL stage 2a study was designed to evaluate the feasibility and safety of solo-surgeon pure laparoscopic living donor nephrectomy (SSPLDN). MATERIALS AND METHODS: The study protocol was approved by the institutional review board of the Asan Medical Center, Seoul, Korea (#2018-0864) and registered on the Clinical Research Information Service site of the Korea Centers for Disease Control and Prevention (#KCT0003458). The patients eligible for all inclusion and exclusion criteria were enrolled in clinical trial and SSPLDN was performed. The feasibility was assessed by the proportion of subjects who could perform SSPLDN without difficulty. The perioperative complications were identified to assess the safety of SSPLDN. RESULTS: Of the 47 potential candidates from November 2018 to August 2019, 40 were enrolled in clinical trial and seven excluded due to declining participation. The feasibility was 100% (40/40). There were fourteen minor intraoperative complications in 10 cases and seventy three minor postoperative complications in 34 cases. Major perioperative complications did not occur. There were no postoperative complications under the influence of solo-surgery. The mean total operation time was 175.6 ± 27.8 minutes and the longest total operation time was 235 minutes. CONCLUSIONS: SSPLDN using passive camera holder is technically feasible and safe.