3D Endoscopic Donor Nephrectomy Versus Robot-Assisted Donor Nephrectomy: a Detailed Comparison of 2 Prospective Cohorts

AbstractBackgroundThere are 2 endoscopic surgical techniques that implement 3D vision to overcome visual misperception: 3D endoscopy and the da Vinci surgical system. 3D endoscopy has several advantages, such as the presence of tactile feedback and easy implementation, at lower costs. We aimed to assess whether 3D endoscopy could be an alternative to the robot during living donor nephrectomy (LDN).MethodsBetween April 2015 and April 2016 we prospectively collected data on 40 patients undergoing 3D endoscopic LDNs in 1 center, performed by a da Vinci certified surgeon. Data on donors' perioperative results and recipient and graft survival were collected. These data were compared to 40 robot-assisted donor nephrectomies (RADNs) performed in the same center (between January 2012 and May 2014).ResultsBaseline characteristics for both groups were comparable. Intraoperative results showed a significantly shorter median skin-to-skin time (STS-time) of 138.5 min. (125.8-163.8) versus 169.0 (141.5-209.8) min. in favour of the 3D group (P=0.001). Warm ischemia time ([WI-time], P=0.003) and hilar phase for both single- (1 artery and vein) and multiple anatomies (≥1 artery and/or vein [P=0.002 and P=0.010, respectively]) were also significantly reduced in favour of the 3D group, with a flat learning curve. Follow-up demonstrated no readmissions, nor significant differences for donors, recipients and graft survival.Conclusions3D endoscopy may be a good alternative to RADN, since morbidity, graft and recipient survival were comparable, with a significantly shorter median STS-time, WI-time and hilar dissection phase. Furthermore, implementation was easy and at lower costs, whilst tactile feedback was preserved. Background There are 2 endoscopic surgical techniques that implement 3D vision to overcome visual misperception: 3D endoscopy and the da Vinci surgical system. 3D endoscopy has several advantages, such as the presence of tactile feedback and easy implementation, at lower costs. We aimed to assess whether 3D endoscopy could be an alternative to the robot during living donor nephrectomy (LDN). Methods Between April 2015 and April 2016 we prospectively collected data on 40 patients undergoing 3D endoscopic LDNs in 1 center, performed by a da Vinci certified surgeon. Data on donors' perioperative results and recipient and graft survival were collected. These data were compared to 40 robot-assisted donor nephrectomies (RADNs) performed in the same center (between January 2012 and May 2014). Results Baseline characteristics for both groups were comparable. Intraoperative results showed a significantly shorter median skin-to-skin time (STS-time) of 138.5 min. (125.8-163.8) versus 169.0 (141.5-209.8) min. in favour of the 3D group (P=0.001). Warm ischemia time ([WI-time], P=0.003) and hilar phase for both single- (1 artery and vein) and multiple anatomies (≥1 artery and/or vein [P=0.002 and P=0.010, respectively]) were also significantly reduced in favour of the 3D group, with a flat learning curve. Follow-up demonstrated no readmissions, nor significant differences for donors, recipients and graft survival. Conclusions 3D endoscopy may be a good alternative to RADN, since morbidity, graft and recipient survival were comparable, with a significantly shorter median STS-time, WI-time and hilar dissection phase. Furthermore, implementation was easy and at lower costs, whilst tactile feedback was preserved. Corresponding author: T.C.K. Tran, MD, Erasmus MC, Department of Surgery's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands. Email: t.tran@erasmusmc.nl. Tel. number: 00317031810. Fax number: 00317032396 Authorship Page Participated in research design: Mulder, Janki, Terkivatan, Klop, IJzermans, Tran Participated in the writing of the paper: Mulder, Janki, Tran Participated in the performance of the research: Mulder, Janki, Terkivatan, Klop, IJzermans, Tran Participated in data analysis: Mulder, Janki, Klop, IJzermans, Tran Critical revision: Mulder, Janki, Terkivatan, Klop, IJzermans, Tran Disclosure The study was supported by Olympus Netherlands B.V., who provided all necessary equipment for free, and the Erasmus MC Efficiency Research grant. E.E.A.P. Mulder, S. Janki, T. Terkivatan, K.W.J. Klop, J.N.M. IJzermans and T.C.K. Tran declare no conflicts of interest or financial ties; neither the investigators nor subjects received compensation for the performance of the study, and the investigators had control of the presentation of the data. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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