In Japan, living kidney donations are increasing instead of decreasing in relation to the number of cadaveric donors. Nowadays, most donors of nephrectomy have been handled through an endoscopic approach. The skill of endoscopic surgery is more crucial to ensure not only graft function, but also more donor safety than nephrectomy from other diseases, such as kidney cancer. Our institute introduced endoscopic living donor nephrectomy in 2002. Ninety-one cases of hand-assisted laparoscopic living donor nephrectomy (HALDN) and more recently 292 cases of retroperitoneoscopic living donor nephrectomy (RPLDN) have been performed. At total of 10 endoscopic donor surgeons (EDS) are now established. The key to technical tradition of living donor nephrectomy is to shorten the learning curve to achieve unchanged graft outcomes and donor safety. Herein we compared the results of 4 experienced surgeons with those of 6 trainees concerning perioperative outcomes, complications, and learning curves to verify our EDS training program.
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