Work

Learning curve comparison between hand-assisted and retroperitoneoscopic living donor nephrectomy using risk-adjusted cumulative sum analysis

Year: 2026

Type: article

Abstract: OBJECTIVE: This study aimed to clarify how learning patterns differ between hand-assisted laparoscopic donor nephrectomy(HALDN) and retroperitoneoscopic donor nephrectomy (RDN) by applying risk-adjusted CUSUM analysis, with the goal of supporting surgical education and decision-making in donor nephrectomy. METHODS: We retrospectively analyzed 128 consecutive living donor nephrectomies performed at a single center, comprising 64 HALDN and 64 RDN cases. Each surgical approach was consistently performed by a different surgeon. Inverse probability weighting (IPW) was used to adjust for background differences using covariates including sex, age, BMI, MAP score, and vascular anatomy. Risk-adjusted CUSUM analysis was conducted for operative time and blood loss, and segmented regression was used to identify inflection points and slope transitions in the learning curve. RESULTS: Baseline characteristics were adjusted using IPW to account for differences between the HALDN and RDN groups. The inflection point in operative time appeared at the 11.8th case for HALDN and at the 34.6th case for RDN. In HALDN, the slope improved from + 103.5 to − 20.9, while in RDN, it changed from + 19.8 to − 30.5. RDN reached CUSUM zero-crossing at case 55, while HALDN did not cross zero. For blood loss, the inflection point was at case 6.6 (HALDN) and 37.8 (RDN), with post-inflection slopes of − 11.5 and − 18.6, respectively. These findings suggest HALDN allows early stabilization, whereas RDN shows greater improvement after achieving proficiency. CONCLUSION: HALDN enables earlier stabilization, whereas RDN shows greater improvement after proficiency. These findings may inform surgical planning and training in donor nephrectomy.

Source: BMC Urology

DOI: 10.1186/s12894-026-02105-5