The Impact of Learning Curve on Robotic Living Donor Nephrectomy Outcomes

Abstract Background: We aimed to investigate how surgeon experience in different time points impact donors’ outcome. Methods: This is a retrospective study comparing outcome of 77 living kidney donors who had robotic living donor nephrectomies (RDN) performed at a single institution. Donors separated into three groups: 25 patients constituting the learning curve period (LCP), 25 patients constituting the stabilization period (SP), and the 27 patients constituting the teaching period (TP). The groups were compared by collecting data on pre-, intra- and postoperative parameters and costs. Results: Among the three RDN groups, there were significant differences in blood loss (102 mL vs 39 mL vs 41 mL, p=0.01), intra-operative fluids administration (3.2 L vs 3.1 L vs 2.7 L, p=0.45), hospitalization times (2.96 days vs 1.92 days vs 1.85 days, p<0.01), and morphine milligram equivalents (MME) (2068 vs 375 vs 222, p<0.01). Operative time was significantly shorter in the LCP group compared to the TP group (282 min vs 308 min vs 314, p=0.02). However, warm ischemia time was shorter in the TP group compared to the LCP group (5.0 min vs 3.4 min vs 1.5 min, p<0.01). Complication rates were significantly higher in the LCP group compared to the SP and TP groups (p=0.04), but readmission within 30 days was similar at all surgical time points(p=0.58). Surgical costs ($73,756 vs $82,949 vs $91783, p<0.01) were higher in both the SP and TP groups. Conclusion: This study has demonstrated that RDN outcomes improve significantly after the initial learning curve of the technique.