The feasibility of solo-surgeon living donor nephrectomy: initial experience using video-assisted minilaparotomy surgery

Today, many kinds of surgery are being conducted without human assistants. Living donor nephrectomy (LDN) using video-assisted minilaparotomy surgery (VAM) has been performed by solo-surgeon using Unitrac(A (R)) (Aesculap Surgical Instrument, Germany). We examined the results from VAM-solo-surgeon living donor nephrectomy (SLDN) and conventional VAM-human-assisted living donor nephrectomy (HLDN). Between July 2007 and April 2008, 82 cases of VAM-LDN were performed by two surgeons. From these cases, we randomly assigned 35 cases to undergo solo-surgery (group I) and the other 47 cases to undergo surgery with one human assistant (group II). All VAM-LDN procedures were performed in the same manner. Only the roles of a first assistant were substituted by the Unitrac(A (R)) in group I. We compared the perioperative and postoperative data, including operative time, estimated blood loss, and hospital stay, between the two groups. We also investigated cases that developed complications. There were no significant differences in the patient demographic data between the two groups (P > 0.05). The mean operative time was 201.9 +/- A 32.9 min in group I and 202.4 +/- A 48.3 min in group II (P = 0.954), whereas mean blood loss was 209.7 +/- A 167.3 ml in group I and 179.6 +/- A 87.8 ml in group II (P = 0.294). Postoperative hospital stay were 5.4 +/- A 1.1 days in group I and 5.5 +/- A 1.6 days in group II (P = 0.813). The incidence of perioperative complications was not significantly different between the two groups. Our study demonstrates that VAM-SLDN can be performed safely, is economically beneficial, and is comparable to VAM-HLDN in terms of postoperative outcomes.